Nutritional profile and lifestyle of patients before and after bariatric surgery
DOI:
https://doi.org/10.15448/1980-6108.2016.3.23707Keywords:
obesity, bariatric surgery, nutritional status, deficiency diseases.Abstract
Aims: To analyze the nutritional profile and the lifestyle of patients before and after bariatric surgery by Roux-en-Y gastric bypass.
Methods: Retrospective cohort study carried out in the period from 2010 to 2014, including data on patients submitted to bariatric surgery by Roux-en-Y gastric bypass in a private hospital located in the northern region of Rio Grande do Sul, Brazil. Sociodemographic data, lifestyle, anthropometric measurements, and the intake of calories, nutrients, vitamins, and mineral salts before surgery and one year thereafter were analyzed. The results for biochemical tests (vitamin B12, hemoglobin, albumin, hematocrit, and ferritin) performed six months to one year after surgery were also assessed.
Results: Fifty patients were included in the study, and 44 (88%) were female. Thirty-five patients (70%) presented with some conditions before surgery, among which high blood pressure (35%) and diabetes mellitus (20%) were the most frequent. Between the preoperative evaluation and one year after the surgery, physical activity level increased (18.0% vs. 90.0%; p=0.001) whereas weight (118.51±21.88 vs. 80.30±15.74), body mass index (43.55±5.52 vs. 29.55±4.21), and abdominal circumference (123.06±16.21 vs. 92.36±11.62) decreased significantly (p<0.001). The intake of calories and of vitamin B12 also decreased significantly (p<0.05). The tests performed within six months to one year after the surgery indicated one patient with vitamin B12 deficiency, seven patients with anemia, and three with ferritin deficiency.
Conclusions: After bariatric surgery by Roux-en-Y gastric bypass there was weight loss, reduction in body mass index and abdominal circumference, and a decrease in sedentary lifestyle. Some nutritional deficiencies were observed, which indicates the need for nutritional management after bariatric surgery in order to ensure a successful outcome.
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References
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: WHO; 2014.
Ministério da Saúde (BR). VIGITEL, Brasil 2014: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2015.
Associação Brasileira para Estudos da Obesidade e da Síndrome Metabólica. Quase 60% dos brasileiros estão acima do peso, revela IBGE [Internet]. 2015 [cited 2016 Jul 14]. Available from: http:// http://www.abeso.org.br/noticia/quase-60-dos-brasileiros-estao-acima-do-peso-revela-pesquisa-do-ibge
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE; 2011.
Bressan J, Costa AGV. Tratamento nutricional da obesidade. In: Nunes MA, Appolinário JC, Galvão AL, Coutinho W, et al. Transtornos Alimentares e Obesidade. 2ª ed. Porto Alegre: Artmed; 2006. p. 315-325.
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due extremely obesity. JAMA. 2003 Jan 8;289(2):187-93. http://dx.doi.org/10.1001/jama.289.2.187
Sjöström L, Gummesson A, Sjöström CD, Narbro K, Peltonen M, Wedel H, Bengtsson C, Bouchard C, Carlsson B, Dahlgren S, Jacobson P, Karason K, Karlsson J, Larsson B, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Carlsson LM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. Lancet Oncol. 2009 Jul;10(7):653-62. http://dx.doi.org/10.1016/S1470-2045(09)70159-7
Sociedade Brasileira de Cirurgia Bariátrica e Metabólica. Número de Cirurgias Bariátricas realizadas no Brasil [Internet]. [cited 2016 Jul 14]. Available from: http:// http://www.sbcb.org.br/imprensa.php?menu=3
Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006; 331:207-13. http://dx.doi.org/10.1097/00000441-200604000-00007
Gong K, Gagner M, Pomp A, Almahmeed T, Bardaro SJ. Micronutrient deficiencies after laparoscopic gastric bypass: recommendations. Obes Surg. 2008;18:1062-66. http://dx.doi.org/10.1007/s11695-008-9577-9
Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008 Sep-Oct;4(5 Suppl):S73-108. http://dx.doi.org/10.1016/j.soard.2008.03.002
Pedrosa IV, Burgos MGPA, Souza NC, Morais CN. Aspectos nutricionais em obesos antes e após a cirurgia bariátrica. Rev Col Bras Cir. 2009;36(4):316-22. http://dx.doi.org/10.1590/S0100-69912009000400008
Beleli CAV, Filho AC, Silva RM, Camargo MA, Scopin DR. Fatores preditivos na perda ponderal de pacientes submetidos ao Bypass Gástrico em Y-de-Roux. BMI. 2011;1:16-23.
Dalcanale L, Oliveira CP, Faintuch J, Nogueira MA, Rondó P, Lima VM, Mendonça S, Pajecki D, Mancini M, Carrilho FJ. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010 Feb;20(2):181-7. http://dx.doi.org/10.1007/s11695-009-9916-5
World Health Organization. Global status report on noncommunicable diseases 2010 - Description of the global burden of NCDs, their risk factors and determinants. Geneva: WHO; 2011.
World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: WHO; 2011.
Institute of Medicine. Dietary Reference intake for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin and choline. Washington: National Academy Press; 1998.
Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington D.C.: National Academy Press; 2004.
Resende LMH, Viana LG, Vidigal PG. Protocolos clínicos dos exames laboratoriais: versão preliminar. Belo Horizonte: UFMG; 2009.
Rangel LOB, Faria VSP, Magalhães EA, Araújo ACT, Bastos EMRD. Perfil de saúde e nutricional de pacientes portadores de obesidade mórbida candidatos à cirurgia bariátrica. Rev Bra Nutr Clin. 2007;22:214-9.
Lehmann ALF, Valezi AC, Brito EM, Marson AC, Souza JCL. Correlação entre hipomotilidade da vesícula biliar e desenvolvimento de colecistolitíase após operação bariátrica. Rev Col Bras Cir. 2006;33:285-8. http://dx.doi.org/10.1590/S0100-69912006000500005
Quadros MRR, Savaris AL, Ferreira MV, Branco Filho AJ. Intolerância alimentar no pós-operatório de pacientes submetidos à cirurgia bariátrica. Rev Bra Nutr Clin. 2007;22:15-9.
Martins, MVDC, Souza AAPS. Mecanismos cirúrgicos de controle do diabetes mellitus tipo 2 após cirurgia bariátrica. Rev Col Bras Cir. 2007;34:343-6. http://dx.doi.org/10.1590/S0100-69912007000500013
Diniz MFHS, Passos VMA, Barreto SM, Diniz MTC, Linares DB, Mendes LN. Perfil de pacientes obesos classe III do Sistema Público de Saúde submetidos à gastroplastia em "Y de ROUX", no Hospital das Clínicas da UFMG: altas prevalências de superobesidade, co-morbidades e mortalidade hospitalar. Rev Med Minas Gerais. 2008;18:183-90.
Lima PAL, Barreto Filho JAS, Oliveira MHA, Almeida F, Moura JS, Alves Junior A. Avaliação dos níveis plasmáticos de IGF-1, glicose e insulina no pré e pós-operatório de pacientes submetidos à cirurgia de fobi-capella. J Port Gastrenterol. 2008;15:196-203.
De Zwaan M, Mitchell JE, Howell LM, Monson N, Swan-Kremeier L, Roerig JL, Kolotkin RL, Crosby RD. Two measures of health-related quality of life in morbid obesity. Obes Res. 2002 Nov;10(11):1143-51. http://dx.doi.org/10.1038/oby.2002.155
Ishitani LH; Franco GC; Perpétuo IHO; França E. Desigualdade social e mortalidade precoce por doenças cardiovasculares no Brasil. Rev Saúde Pública. 2006;4(4): 684-91. http://dx.doi.org/10.1590/S0034-89102006000500019
Galvão TD. Consumo de bebida alcoólica após a cirurgia bariátrica [Internet]. 2014 [cited 2015 Sept 20]. Available from: http://www.drthalesdelmondes.com.br/consumo-de-bebida-alcoolica-apos-a-cirurgia-bariatrica
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219-25. http://dx.doi.org/10.1097/00000441-200604000-00009
Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004 Jan;8(1):48-55; discussion 54-5. http://dx.doi.org/10.1016/j.gassur.2003.09.020
Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, Cody RP. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg. 1998 Sep-Oct;2(5):436-42. http://dx.doi.org/10.1016/S1091-255X(98)80034-6
Higa K, Ho T, Tercero F, Yunus T, Boone KB. Long-term results after laparoscopic roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011 Jul-Aug;7(4):516-25. http://dx.doi.org/10.1016/j.soard.2010.10.019
Mango VL, Frishman WH. Physiologic, psychologic, and metabolic consequences of bariatric surgery. Cardiol Rev. 2006 Sep-Oct;14(5):232-7. http://dx.doi.org/10.1097/01.crd.0000223656.06812.ae
Farias LM, Coêlho MPSS, Barbosa RF, Santos GS, Marreiro DN. Aspectos nutricionais em mulheres obesas submetidas à gastroplastia vertical com derivação gastro-jejunal em Y-de- Roux. Rev Bra Nutr Clin. 2006;21:98-103.
Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Rouxen- Y gastric bypass and after biliopancreatic diversion with Rouxen-Y gastric bypass. Obes Surg. 2002;12:551-8. http://dx.doi.org/10.1381/096089202762252334
Amaral JF, Thompson WR, Caldwell MD, Martin HF, Randall HT. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201(2):186-93. http://dx.doi.org/10.1097/00000658-198502000-00009
Brolin RE, Gorman RC, Milgrim LM, Kenler HA. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991;15(10):661-7.
Santos LA. Avaliação nutricional de pacientes obesos antes e seis meses após a cirurgia bariátrica [Dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2007.
Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331(4):207-13. http://dx.doi.org/10.1097/00000441-200604000-00007
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219-25. http://dx.doi.org/10.1097/00000441-200604000-00009
Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28(2):481-4. http://dx.doi.org/10.2337/diacare.28.2.481
Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54:824-44. http://dx.doi.org/10.1016/j.jaad.2005.11.1104
Valezi AC, Júnior, JM, Brito EM, Marson AC. Gastroplastia vertical com bandagem em Y–de-roux: análise de resultados. Rev Col Bras Cir. 2004;31(1):49-56. http://dx.doi.org/10.1590/S0100-69912004000100010
Garrido Júnior AB, Ferraz EM, Barroso FL, Marchesini JB, Szegö T. Cirurgia da obesidade. São Paulo: Atheneu Editora; 2013.
Carvalho PS, Moreira CLCB, Barelli MC, Oliveira FH, Guzzo MF, Miguel GP, Zandonade E. Cirurgia bariátrica cura síndrome metabólica? Arq Bras Endocrinol Metab. 2007;51:79-85. http://dx.doi.org/10.1590/S0004-27302007000100013
Santos EMC, Burgos MGPA, Silva SA. Perda ponderal após cirurgia bariátrica de Fobi-Capella: realidade de um hospital universitário do nordeste brasileiro. Rev Bra Nutr Clin. 2006;21:188-92.
Sociedade Brasileira de Cardiologia. I diretriz brasileira de diagnóstico e tratamento da síndrome metabólica. Rio de Janeiro: Sociedade Brasileira de Cardiologia; 2005.
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008 Sep-Oct;4(5 Suppl):S109-84. http://dx.doi.org/10.1016/j.soard.2008.08.009
