Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation.

Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.

Nutritional care is a human right: Translating principles to clinical practice.

We have previously advocated that nutritional care be raised to the level of a human right in a close relationship to two well recognized fundamental rights: the right to food and the right to health. This paper aims to analyze the implication of nutritional care as a human right for healthcare practitioners. We will focus on the impact of the Human Rights Basic Approach (HRBA) on health care professionals (HCPs), namely how they can translate HRBA into routine clinical practice. Ethics and human rights are guiding values for clinical nutrition practitioners. Together they ensure a patient-centered approach, where the needs and rights of the patients are of the most significant importance. Human rights are based on the powerful idea of equal dignity for all people while expressing a set of core values, including fairness, respect, equality, dignity, and autonomy (FREDA). Through the analysis of FREDA principles, we have provided the elements to understand human rights and how a HRBA can support clinicians in the decision-making process. Clinical practice guidelines in clinical nutrition should incorporate disease-specific ethical issues and the HRBA. The HRBA should contribute to build conditions for HCPs to provide optimal and timely nutritional care. Nutritional care must be exercised by HCPs with due respect for several fundamental ethical values: attentiveness, responsibility competence, responsiveness, and solidarity.

Nutritional care is a human right: Translating principles to clinical practice.

We have previously advocated that nutritional care be raised to the level of a human right, in close relationship to two well-recognized fundamental rights: the right to food and the right to health. This article aims to analyze the implication of nutritional care as a human right for healthcare practitioners. We will focus on the impact of the Human Rights Basic Approach (HRBA) on healthcare professionals (HCPs), namely how they can translate HRBA into routine clinical practice. Ethics and human rights are guiding values for clinical nutrition practitioners. Together they ensure a patient-centered approach, in which the needs and rights of the patients are of the most significant importance. Human rights are based on the powerful idea of equal dignity for all people while expressing a set of core values, including fairness, respect, equality, dignity, and autonomy (FREDA). Through the analysis of FREDA principles, we have provided the elements to understand human rights and how an HRBA can support clinicians in the decision-making process. Clinical practice guidelines in clinical nutrition should incorporate disease-specific ethical issues and the HRBA. The HRBA should contribute to building conditions for HCPs to provide optimal and timely nutritional care. Nutritional care must be exercised by HCPs with due respect for several fundamental ethical values: attentiveness, responsibility competence, responsiveness, and solidarity.

First-trimester adiponectin and subsequent development of preeclampsia or fetal growth restriction.

BACKGROUND/AIMS: The evidence regarding the utility of assessing first-trimester adiponectin (ApN) serum levels in early prediction of preeclampsia (PE) and fetal growth restriction (FGR) is contradictory. This study aims to determine the role of maternal serum ApN levels as an early predictor of PE and FGR. METHODS: A prospective case-control study among a pregnant population who attended their 11- to 14-week ultrasound scan at the University of Chile's Clinical Hospital's Fetal Medicine Unit. We included patients who developed PE or FGR (10 cases per group) and 35 healthy controls. We determined ApN levels in blood samples from these 55 patients using a commercial ELISA kit and assessed the relationship of ApN levels with variables like development of PE, FGR, weight at birth and maternal BMI. RESULTS: There were no significant differences among first-trimester ApN serum levels in the groups. Average concentrations were 8, 6.8 and 10.8 ng/ml for the control, PE and FGR groups, respectively. CONCLUSION: In our study, maternal serum ApN levels were not useful in predicting subsequent development of PE and FGR. However, maternal serum ApN concentration adjusted by BMI was significantly higher during the first trimester in women who later developed FGR.

Zinc absorption and zinc status are reduced after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women with severe obesity studied prospectively over 24 postoperative months.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is known to reduce zinc absorption; the effects of vertical sleeve gastrectomy (SG) and its long-term implications on zinc absorption have not yet been studied. OBJECTIVE: The aim was to evaluate the effects of SG and RYGBP on zinc absorption and zinc status in premenopausal women with severe obesity up to 24 mo after surgery. METHODS: Twenty-six premenopausal women undergoing SG [BMI (in kg/m2): 37.3 ± 3.2] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2) were studied. A series of anthropometric, dietary, and zinc status parameters (plasma and hair zinc), and the size of the exchangeable zinc pool (EZP), as well as percentage zinc absorption from a standardized dose using a stable isotope methodology were evaluated in the patients before the surgical procedure and at 12 and 24 mo after SG or RYGBP. SG patients received 15 mg and RYGBP received 25 mg of supplemental Zn/d. RESULTS: In premenopausal women, zinc absorption was decreased by 71.9% and 52.0% in SG and RYGBP, respectively, 24 mo postsurgery, compared with initial values. According to 2-factor repeated-measures ANOVA, time effect was significant (P = <0.0001), but not time × group interaction (P = 0.470). Plasma zinc below the cutoff point of 70 µg/dL increased from 0 to 15.4% and 38.1% in SG and RYGBP, respectively. Mean EZP was significantly reduced 24 mo after surgery, although no time × group interactions were observed. Hair zinc did not change across time or between groups. CONCLUSIONS: Both SG and RYGBP have profound effects on zinc absorption capacity, which are not compensated for after 24 mo. Although zinc absorption reduction was similar in both types of surgeries, plasma zinc was more affected in RYGBP than SG, despite greater zinc supplementation in RYGBP.This trial was registered at http://www.isrctn.com as ISRCTN31937503.

Clinical Nutrition and Human Rights. An International Position Paper.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Clinical nutrition and human rights. An international position paper.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

[Body composition assessment before and after weight loss following a Roux-en-Y gastric bypass. Are bioimpedanciometry estimations reliable?] / Evaluación de la composicion corporal antes y después de la reducción de peso con baipás gastrico en Y de Roux. ¿Son confiables las mediciones de la bioimpedanciometría?

INTRODUCTION: Introduction: in patients with severe and morbid obesity it has been observed that bioimpedance (BIA) assessment generates an underestimation of fat mass (FM) and weight loss as FM after bariatric surgery, overestimating the loss of fat-free mass (FFM) and muscle mass. Objective: to evaluate the reliability of bioelectrical impedance analysis (BIA) to estimate total body water (TBW), fat-free mass (FFM), fat mass (FM), and its changes after 6 months of a Roux-en-Y gastric bypass (RYGBP), in patients with severe and morbid obesity. Methods: thirty-six patients approved for RYGBP were prospectively studied. TBW was measured by deuterium (D), and FM and FFM were calculated. A dual-frequency BIA device (5 and 200 kHz) (Bodystat Dualscan®) was used to estimate FM, FFM, TBW, extracellular water (ECW), intracellular water (ICW), and ECW/ICW ratio. Results: before RYGBP, BIA overestimated TBW by 2.6 ± 4.3 L (p = 0.002) and FFM by 3.5 ± 5.7 kg (p = 0.002), and underestimated FM% by 2.98 ± 4.7% (p = 0.002). The ECW/ICW ratio showed a significant and positive correlation with the difference BIA-D for FFM (r = 0.49; p = 0.002). After surgery, the differences between BIA and D were not significant, and the estimation error of FFM did not correlate with the ECW/ICW ratio. Conclusions: BIA generates an underestimation of FM as reported in patients with severe and morbid obesity, which is attenuated after weight reduction, underestimating weight loss as FM and overestimating FFM loss. Future research may assess whether these errors are reproduced by other BIA devices.

INTRODUCCIÓN: Introducción: en pacientes con obesidad severa y mórbida se ha observado que la evaluación por bioimpedanciometría (BIA) genera una subestimación de la masa grasa (MG) y del peso perdido como MG después de la cirugía bariátrica, sobreestimándose la pérdida de masa libre de grasa (MLG) y la masa muscular. Objetivo: evaluar la confiabilidad de la BIA para estimar el agua corporal total (ACT), la MLG, la MG y sus cambios después de 6 meses de un baipás gástrico en Y de Roux (BPGYR) en pacientes con obesidad severa y mórbida. Métodos: 36 adultos con indicación de BPGYR se estudiaron prospectivamente. Se midió el ACT por deuterio (D) y se calcularon la MLG y MG. Con BIA de doble frecuencia (5 y 200 kHz) (Bodystat Dualscan®) se estimaron la MG, la MLG, el ACT, el agua extracelular (AEC), el agua intracelular (AIC) y la relación AEC/AIC. Resultados: antes del BPGYR, la BIA sobreestimó el ACT en 2,6 ± 4,3 L (p = 0,002) y la MLG en 3,5 ± 5,7 kg (p = 0,002), y subestimó el %MG en 2,98 ± 4,7% (p = 0,002). La relación AEC/AIC mostró una correlación positiva con la sobreestimación de la MLG por BIA (r = 0,49; p = 0,002). Después de la cirugía, las diferencias entre BIA y D no fueron significativas y el error de estimación de la MLG no se correlacionó con la relación AEC/AIC. Conclusiones: la BIA genera una subestimación de la MG como la reportada, la cual se atenúa después de la reducción de peso, subestimando el peso perdido como MG y sobreestimando la pérdida de MLG. Futuras investigaciones podrán evaluar si estos errores se reproducen con otros equipos de BIA.

Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery.

BACKGROUND: Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted. METHODS: Forty-two women (BMI 45.0 +/- 4.3 kg/m(2); 37.7 +/- 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA. RESULTS: Twelve months after, GBP weight was decreased by 34.4 +/- 6.5% and excess weight loss was 68.2 +/- 12.8%. Significant reduction (p < 0.001) in total BMD (-3.0 +/- 2.1%), spine BMD (-7.4 +/- 6.8%) and hip BMD (-10.5 +/- 5.6%) were observed. Adiponectin concentration increased from 11.4 +/- 0.7 mg/L before surgery to 15.7 +/- 0.7 and 19.8 +/- 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r (2) = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36). CONCLUSION: GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.

Evaluation of the radiological gastric capacity and evolution of the BMI 2-3 years after sleeve gastrectomy.

BACKGROUND: Sleeve gastrectomy is a restrictive procedure for treatment of obese patients with different body mass index (BMI) and presents good results in terms of a reduction of percentage of excess weight loss and BMI. There is no consensus which is the optimal technique regarding to the diameter of the gastric tube, but a capacity of 100-120 ml has been suggested. In this prospective study, we compare the gastric capacity evaluated with barium sulfate or computer-aided tomography (CAT) scan early and 24 months after operation compared to the changes in body weight and BMI reduction in a small group of 15 consecutive patients submitted to sleeve gastrectomy. METHODS: Fifteen successive obese patients submitted to laparoscopic sleeve gastrectomy were included. They were studied in order to measure the residual gastric capacity with barium sulfate and CAT scan early (3 days) and late (2 years) after surgery. RESULTS: The early postoperative gastric volume was 108 +/- 25 ml (80-120 ml) and 116.2 +/- 78.24 assessed with barium sulfate and CAT scan, respectively. The gastric capacity at the late control increased to 250 +/- 85 and 254 +/- 56.8 assessed with the same techniques. However, patients remained stable with a BMI close to 25 without regain of weight at least at the time of observation. CONCLUSIONS: Gastric capacity can increase late after sleeve gastrectomy even after performing a narrow gastric tubulization. It is very important to measure objectively residual gastric volume after sleeve gastrectomy and its eventual increase in order to determine the late clinical results and to indicate eventual strategy for retreatment.

Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study.

Background: Although Roux-en-Y gastric bypass (RYGBP) is known to reduce calcium absorption (CA), the effects of vertical sleeve gastrectomy (SG) and its long-term implications on CA have not yet been studied. Objective: The aim of this study was to evaluate changes in CA and its relation with modifications of bone mineral density (BMD), intakes of calcium and vitamin D, vitamin D status, and parathyroid hormone (PTH) concentrations ≤24 mo after SG and RYGBP, respectively. Design: Twenty-six premenopausal women undergoing SG [mean ± SD body mass index (BMI; kg/m2): 37.3 ± 3.2; age: 34.2 ± 10.2 y] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2; age: 37.3 ± 8.1 y) were studied at baseline (presurgery) and followed up at 12 and 24 mo after surgery. BMD, bone alkaline phosphatase activity, and serum PTH, 25-hydroxyvitamin D [25(OH)D], calcium, magnesium, and phosphorus concentrations were determined. Food and supplement intakes were recorded. CA was measured by using a dual stable isotope method. Results: In premenopausal women, CA was significantly reduced from 36.5% ± 2.0% preoperatively to 21.0% ± 2.3% and 18.8% ± 3.4% at 12 and 24 mo post-SG surgery, respectively. CA also decreased significantly from 41.5% ± 2.8% preoperatively to 27.9% ± 3.8% and 18.5% ± 2.2% 12 and 24 mo after RYGBP, respectively. No difference was found between type of surgery (time × group interaction, P = 0.60). Considering both groups combined, 56.6% of the variance in CA at the 12-mo but not at the 24-mo follow-up was explained by serum PTH and 25(OH)D concentrations, together with vitamin D and calcium intakes. Conclusions: CA was similarly reduced in both SG and RYGBP compared with baseline, and it was not associated with changes in BMD or body weight loss. This reduction in CA could be explained only partially by calcium intake increase. This trial is registered at http://www.isrctn.com as ISRCTN31937503.

Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass.

BACKGROUND: The objective of this study was to evaluate changes in resting energy expenditure (REE), body composition and metabolic parameters, and to investigate predictors of the results in seriously obese patients after Roux-en-Y gastric bypass (RYGBP). METHODS: 31 patients (BMI 44.4 +/- 4.8 kg/m2; 27 female, 4 male; 37.3 +/- 11.1 y) were evaluated at baseline and 6 months after RYGBP. Weight, REE, waist circumference (WC), fat mass (FM) and fat-free mass (FFM), physical activity, food intake, fasting glucose (GLU), insulin (INS), HOMA-IR and lipid concentrations were measured. RESULTS: At 6 months, percentage of weight loss (%WL) was 29.0 +/- 4.4% and percentage of excess weight loss was (%EWL) 59.7 +/- 12.3%. FM loss corresponded to 77.1 +/- 12.2% of the weight loss. REE decreased from 33.4 +/- 4.1 to 30.1 +/- 2.6 kcal/kg FFM (P<0.05). Significant decreases (P<0.001) were observed in GLU, INS, HOMA-IR, LDL-cholesterol and triglycerides. %EWL was correlated with baseline INS (r=0.44; P=0.014), baseline HOMA (r=0.43; P=0.017), change in %FM (r=0.67; P<0.001) and change in WC (r=0.5; P<0.01). Decrease in REE/FFM (%) was positively correlated with baseline REE/FFM% (r=0.51; P<0.005) and change in %FM (r=0.69; P<0.001). Initial REE/FFM, baseline energy balance and FM change explain 90% of REE/FFM decrease. CONCLUSION: RYGBP was an effective procedure to induce significant weight loss, fat mass loss and improvement in metabolic parameters in the short term. Metabolic adaptation was not related to FFM wasting but to a higher baseline REE. Fasting hyperinsulinemia was the best single predictor of weight loss after RYGBP.

Persistent anemia after Roux-en-Y gastric bypass.

OBJECTIVE: We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass. METHODS: The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y. RESULTS: The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively. CONCLUSION: Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.

Micronutrient Deficiencies in Morbidly Obese Women Prior to Bariatric Surgery.

BACKGROUND: Although morbid obesity is related to excess of energy and macronutrient intake, it does not rule out the presence of micronutrient deficiencies. The aim of this study was to evaluate food intake and the prevalence of micronutrient deficiencies in a group of morbidly obese women seeking bariatric surgery. METHODS: A total of 103 morbidly obese women were studied prior to bariatric surgery. Anthropometry and body composition (dual-energy X-ray absorptiometry, DEXA) were performed on all subjects. Energy and nutrient intake was determined by food frequency questionnaire. Blood tests to assess micronutrients status, including plasma iron, ferritin, transferrin, zinc, copper, calcium, phosphorus, hemoglobin, hematocrit, mean corpuscular volume (MCV), and hair zinc, were performed. Folic acid, vitamin B12, vitamin D, and parathyroid hormone (PTH) were also assessed in 66 subjects. RESULTS: Mean energy intake was 2801 ± 970 kcal/day. Carbohydrate, protein, and lipid intake represented 55 ± 9.1, 13.9 ± 3.3, and 32.5 ± 8.2% of total energy intake, respectively. Iron, calcium, and vitamin D intake was below the recommended dietary allowance. The prevalence of nutritional deficiencies were as follows: plasma iron 12.6%, ferritin 8.7%, transferrin 14.6%, plasma zinc 2.9%, calcium 3.3%, phosphorus 2.3%, hemoglobin 7.7%, hematocrit 13.6%, MCV 6.8%, and hair zinc 15.7%. In the subsample, 10.6% had a vitamin B12 deficiency, 71.7% showed low concentrations of vitamin D, and 66% had high PTH levels. No folic acid or copper deficiencies were detected. CONCLUSIONS: Despite high daily energy intake and adequate macronutrient distribution, morbidly obese Chilean women seeking bariatric surgery present with deficient intake of some micronutrients and a high prevalence of micronutrient deficiencies.

Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity.

Surgical treatment is the procedure of choice for morbidly obese patients. Gastric bypass with a long limb Roux-en-Y anastomosis is the "gold standard" technique for these patients. We sought to determine the early and late results of open gastric bypass with resection of the distal excluded stomach in patients with morbid obesity. We included in this prospective study 400 patients who were seen from September 1999 through August 2003 (311 women and 89 men; mean age, 38.5 years). The mean body mass index of the patients was 46 kg/m2. All underwent 95% distal gastrectomy, with resection of the bypassed stomach, leaving a small gastric pouch of 15 to 20 ml. An end-to-side gastrojejunostomy was performed with circular stapler No. 25. The length of the Roux-en-Y loop was 125 to 150 cm. In all patients, a biopsy was taken from the liver and routine cholecystectomy was performed. Follow-up was as long as 36 months. A barium study was performed in all patients at 5 days after surgery. Mortality and postoperative morbidity rates were 0.5% and 4.75%, respectively, mainly due to anastomotic leak in 10 patients (2.5%). Hospital length of stay was 7 days for 95% of the patients. Follow-up data for longer than 12 months were available in 184 patients. There was excess body weight loss of 70% at 24 and 36 months, and there was an inverse correlation among preoperative body mass index and the loss of weight. Anemia was present in 10%, and incisional hernia was present in 10.2%. At 1 year after surgery, the BAROS index demonstrated very good or excellent index in 96.6% of the patients. Gastric bypass with resection of the distal excluded segment has results very similar to those of gastric bypass alone but eliminates the potential risks of gastric bypass such as anastomotic ulcer, gastrogastric fistula, postoperative bleeding due to peptic ulcer and gastritis, and the eventual future development of gastric cancer. It is also possible to perform via laparoscopy, as we started to do recently.

Evaluación de la composicion corporal antes y después de la reducción de peso con baipás gastrico en Y de Roux. ¿Son confiables las mediciones de la bioimpedanciometría? / Body composition assessment before and after weight loss following a Roux-en-Y gastric bypass. Are bioimpedanciometry estimations reliable?

INTRODUCCIÓN: en pacientes con obesidad severa y mórbida se ha observado que la evaluación por bioimpedanciometría (BIA) genera una subestimación de la masa grasa (MG) y del peso perdido como MG después de la cirugía bariátrica, sobreestimándose la pérdida de masa libre de grasa (MLG) y la masa muscular. OBJETIVO: evaluar la confiabilidad de la BIA para estimar el agua corporal total (ACT), la MLG, la MG y sus cambios después de 6 meses de un baipás gástrico en Y de Roux (BPGYR) en pacientes con obesidad severa y mórbida. MÉTODOS: 36 adultos con indicación de BPGYR se estudiaron prospectivamente. Se midió el ACT por deuterio (D) y se calcularon la MLG y MG. Con BIA de doble frecuencia (5 y 200 kHz) (Bodystat Dualscan(R)) se estimaron la MG, la MLG, el ACT, el agua extracelular (AEC), el agua intracelular (AIC) y la relación AEC/AIC. RESULTADOS: antes del BPGYR, la BIA sobreestimó el ACT en 2,6 ± 4,3 L (p = 0,002) y la MLG en 3,5 ± 5,7 kg (p = 0,002), y subestimó el %MG en 2,98 ± 4,7% (p = 0,002). La relación AEC/AIC mostró una correlación positiva con la sobreestimación de la MLG por BIA (r = 0,49; p = 0,002). Después de la cirugía, las diferencias entre BIA y D no fueron significativas y el error de estimación de la MLG no se correlacionó con la relación AEC/AIC. CONCLUSIONES: la BIA genera una subestimación de la MG como la reportada, la cual se atenúa después de la reducción de peso, subestimando el peso perdido como MG y sobreestimando la pérdida de MLG. Futuras investigaciones podrán evaluar si estos errores se reproducen con otros equipos de BIA

INTRODUCTION: in patients with severe and morbid obesity it has been observed that bioimpedance (BIA) assessment generates an underestimation of fat mass (FM) and weight loss as FM after bariatric surgery, overestimating the loss of fat-free mass (FFM) and muscle mass. OBJECTIVE: to evaluate the reliability of bioelectrical impedance analysis (BIA) to estimate total body water (TBW), fat-free mass (FFM), fat mass (FM), and its changes after 6 months of a Roux-en-Y gastric bypass (RYGBP), in patients with severe and morbid obesity. METHODS: thirty-six patients approved for RYGBP were prospectively studied. TBW was measured by deuterium (D), and FM and FFM were calculated. A dual-frequency BIA device (5 and 200 kHz) (Bodystat Dualscan(R)) was used to estimate FM, FFM, TBW, extracellular water (ECW), intracellular water (ICW), and ECW/ICW ratio. RESULTS: before RYGBP, BIA overestimated TBW by 2.6 ± 4.3 L (p = 0.002) and FFM by 3.5 ± 5.7 kg (p = 0.002), and underestimated FM% by 2.98 ± 4.7% (p = 0.002). The ECW/ICW ratio showed a significant and positive correlation with the difference BIA-D for FFM (r = 0.49; p = 0.002). After surgery, the differences between BIA and D were not significant, and the estimation error of FFM did not correlate with the ECW/ICW ratio. CONCLUSIONS: BIA generates an underestimation of FM as reported in patients with severe and morbid obesity, which is attenuated after weight reduction, underestimating weight loss as FM and overestimating FFM loss. Future research may assess whether these errors are reproduced by other BIA devices

[Bone mineral density disminution post Roux-Y bypass surgery]. / Disminución de masa ósea post-cirugía bariátrica con by-pass en Y de Roux.

INTRODUCTION: Bariatric surgery has important metabolic complications such as bone mass loss. GOAL: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria's, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female's subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION: Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.

Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo.

Type 2 diabetes mellitus in patients with mild obesity: preliminary results of surgical treatment.

In the last years, type 2 diabetes mellitus (T2DM) and obesity have become a serious public health problem, behaving as epidemic diseases. There is great interest in exploring different options for the treatment of T2DM in nonmorbidly obese patients. The purpose of this study is to report parameters of glycemic control in patients with T2DM and mild obesity who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP). This prospective clinical trial includes patients with T2DM with a body mass index (BMI) between 30 and 35 kg/m(2) who underwent laparoscopic RYGBP from July 2008 through October 2010. Thirty-one patients were included in the study, 15 men and 16 women, with an average age of 48.7 ± 8.6 years. The average time since onset of T2DM was 5.8 years. The average postoperative follow-up was 30.4 months. The average preoperative blood glucose and glycosylated hemoglobin were 152 ± 70 mg/dl and 7.7 ± 2.1 %, respectively. All of them were using oral hypoglycemic agents, and four patients were insulin dependent. Only one patient had a postoperative complication (hemoperitoneum). At 36 months follow-up, the average BMI decreased to 24.7 kg/m(2), all patients (31) showed improvement in their glycemic control, and 29 of them (93.6 %) met the criteria for remission of T2DM in the last control. Laparoscopic RYGBP is a safe and effective procedure that improves glycemic control in patients with T2DM and mild obesity at midterm follow-up.

Is laparoscopic sleeve gastrectomy an acceptable primary bariatric procedure in obese patients? Early and 5-year postoperative results.

In this paper, we analyze and discuss the possibility of Laparoscopic sleeve gastrectomy being accepted as a primary and definitive procedure for obese patients with comorbidities. This is based on our postoperative and 5 years of follow-up result and comparing them with the data reported in the international literature. For comparison of the results, a narrative revision of the literature was performed, using the Medline, Pubmed, and data base publications (Medline, Lilacs, and Cochrane Library), looking for the term "Sleeve gastrectomy," "Obesity," "Bariatric surgery," "Laparoscopic surgery" including "Review" articles and also other 42 selected papers. The current results demonstrate very low morbidity (<10%), nil mortality (<1%), mean % weight loss after 5 years of follow-up of 57%, very satisfactory results regarding comorbidities or improvement. However, gastroesophageal reflux manifestation after the operation (20% to 31%) and the possibility of regaining weight after 5 years (15% to 75%) appear as points for analysis.

Changes in ghrelin concentrations one year after resective and non-resective gastric bypass: associations with weight loss and energy and macronutrient intakes.

OBJECTIVE: Ghrelin is a potent stimulator of appetite and synthesized in the stomach. Its role in weight loss after gastric bypass (GBP) is still controversial. The aim of this study was to evaluate the relation between weight loss and food intake and between weight loss and changes in serum ghrelin concentrations 1 y after GBP with resection of the bypassed stomach (R-GBP) and without resection (NR-GBP). METHODS: Of 50 women (37.6 ± 10.2 y old, body mass index 43.8 ± 4.8 kg/m²) with GBP, 26 had R-GBP and 24 had NR-GBP. Body weight, body composition (dual energy x-ray absorptiometry), food intake, and serum ghrelin at baseline and 12 mo after GBP were measured. RESULTS: The percentage of excess weight loss was 68.9 ± 12.8% at 12 mo after GBP. At 12 mo, the decrease of serum ghrelin was greater in the R-GBP group (-25.3 ± 22.5%) compared with the NR-GBP group (+11.2 ± 50.9%, P < 0.005). After adjustment by the baseline excess of body weight, there was a greater percentage of excess weight loss in the R-GBP group only at 6 mo (61.8% versus 54.9%, P = 0.011). After controlling for the baseline intake, a significant lower carbohydrate intake was observed in the R-GBP group 6 mo after surgery (P < 0.05). CONCLUSION: A greater decrease in ghrelin levels was observed only in patients who underwent R-GBP at 12 mo after surgery. This difference was not associated with differences in dietary intakes or weight loss at the same time point. Therefore, the small gastric pouch is probably more important than decreased ghrelin levels in producing long-term weight loss after R-GBP.