RESUMEN
Few data exist concerning preoperative nutritional status in patients undergoing bariatric surgery. We retrospectively analyzed the preoperative values of serum albumin, calcium, 25-OH vitamin D, iron, ferritin, hemoglobin, vitamin B12, and thiamine in 379 consecutive patients (320 women and 59 men; mean body mass index 51.8 +/- 10.6 kg/m2; 25.8% white, 28.4% African American, 45.8% Hispanic) undergoing bariatric surgery between 2002 and 2004. Preoperative deficiencies were noted for iron (43.9%), ferritin (8.4%), hemoglobin (22%; women 19.1%, men 40.7%), thiamine (29%), and 25-OH vitamin D (68.1%). Low ferritin levels were more prevalent in females (9.9% vs. 0%; P = 0.01); however, anemia was more prevalent in males (19.1% vs. 40.7%; P < 0.005). Patients younger than 25 years were more likely to be anemic than patients over 60 years (46% vs. 15%; P < 0.005). This correlated with iron deficiency, which was more prevalent in younger patients (79.2% vs. 41.7%; P < 0.005). Whites (78.8%) and African Americans (70.4%) had a higher prevalence of vitamin D deficiency than Hispanics (56.4%), P = 0.01. Whites were the least likely group to be thiamine deficient (6.8% vs 31.0% African Americans and 47.2% Hispanics; P < 0.005). Nutritional deficiencies are common in patients undergoing Roux-en-Y gastric bypass, and these deficiencies should be detected and corrected early to avoid postoperative complications.
Asunto(s)
Derivación Gástrica , Estado Nutricional , Obesidad Mórbida/metabolismo , Obesidad Mórbida/cirugía , Adulto , Anemia Ferropénica/diagnóstico , Avitaminosis/diagnóstico , Calcio/deficiencia , Femenino , Ferritinas/deficiencia , Hemoglobinas/deficiencia , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Albúmina Sérica/metabolismo , Vitaminas/metabolismoRESUMEN
BACKGROUND: Performance of bariatric surgery in patients with human immunodeficiency virus (HIV) infection is controversial. The advent of highly active antiretroviral treatment (HAART) has dramatically reduced the progression of HIV/AIDS, so that these individuals live longer, with nearly undetectable viral loads, and thus may develop obesity and similar obesity-related comorbidity as occurs in the general population. However, HAART also causes lipodystrophy, placing these patients at increased risk for coronary artery disease. METHODS: This was a retrospective study of 6 patients from a prospectively maintained database of 892 patients (0.71%) undergoing bariatric surgery between June 1999 and December 2003. RESULTS: Six HIV-infected patients (4 women, 2 men; mean age, 43 years [range, 28-56 years]; mean preoperative weight, 142 kg [range, 110-174 kg]; mean preoperative body mass index, 50 [range, 42-59) underwent Roux-en-Y gastric bypass (RYGB). The mean duration of HIV infection was 9 years; 33% were receiving HAART at the time of surgery, which was discontinued perioperatively for 2-3 days. Average CD4 cell count was 619 cells/mm3 (range, 361-1096 cells/mm3). Preoperative comorbidities included type 2 diabetes mellitus/impaired glucose tolerance (3 cases), hypertension (2 cases), dyslipidemia (2 cases), coronary artery disease/chronic heart failure (1 case), sleep apnea (4 cases), asthma (2 cases), gastroesophageal reflux disease (3 cases), arthritis (5 cases), and depression (3 cases). Average preoperative length of hospital stay was 4.2 days (range, 3-5 days). There were no deaths or postoperative infectious complications. Mean percent excess body weight loss was 33% at 3 months, 47% at 6 months, and 61% at 12 months. Mean percent initial body weight lost was 19% at 3 months, 26% at 6 months, and 33% at 12 months. CONCLUSION: RYGB can be safely performed in HIV-infected individuals. Initial results appear to be comparable to those in noninfected controls. Well-controlled HIV infection should not be an absolute contraindication to bariatric surgery.
Asunto(s)
Cirugía Bariátrica/métodos , Seropositividad para VIH , Obesidad Mórbida/cirugía , Adulto , Anastomosis en-Y de Roux , Índice de Masa Corporal , Recuento de Linfocito CD4 , Comorbilidad , Femenino , Derivación Gástrica , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Inadequate protein intake is a concern following Roux-en-Y gastric bypass (RYGBP). The small gastric pouch and bypass restrict energy intake and may lead to insufficient protein intake and absorption, and excess loss of lean tissue. METHODS: We evaluated protein intake in 93 (77 F, 16 M) morbidly obese individuals (BMI = 52.0 +/- 12.9 [SD]) who underwent RYGBP at our medical center. Participants completed 24-hr food recalls and received nutritional counseling at 3, 6, and 12 months following surgery. RESULTS: Daily energy intake (kcal/day) increased from 849 +/- 329 (SD) at 3 months to 1,101 +/- 400 at 12 months (P = .009). Protein intake also increased (g/day) from 45.6 +/- 14.2 at 3 months to 58.5 +/- 17.1 at 12 months (P = .04), and as a percentage of goal protein intake from 55.1% +/- 23.0 at 3 months to 73.5% +/- 38.0 at 12 months (P = .02). Although energy and protein intake increased significantly over the 12-month period, protein intake at 12 months remained significantly lower (P = .01) than the daily recommended guidelines (1.5 g/kg IBW) for a low-energy restrictive diet. Energy intake did not differ in those who reported food intolerances at 3 months (P = .77) or 6 months (P = .65), but was lower in them at 12 months (trend, P = .06). Also at 12 months, protein intake (P = .02) and percentage of protein intake goal (P = .04) were significantly lower in those with protein intolerance. CONCLUSIONS: These results suggest that postoperative patients consume insufficient amounts of protein, possibly mediated by protein intolerance. Protein supplementation following RYGBP deserves further consideration.