RESUMEN
PURPOSE: Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years. MATERIALS AND METHODS: Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm2). RESULTS: We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118-1.256) and in total proximal femur (OR=1.158; 95% CI 1.066-1.258), both after adjusting for follow-up and excess weight loss. CONCLUSION: After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.
Asunto(s)
Enfermedades Óseas Metabólicas , Derivación Gástrica , Obesidad Mórbida , Deficiencia de Vitamina D , Humanos , Femenino , Masculino , Densidad Ósea , Calcio , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Vitamina D , Hormona Paratiroidea , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiologíaRESUMEN
BACKGROUND: There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting energy and protein balance and avoiding fasting could improve outcomes in this population with high-risk nutrition outcomes. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. METHODS: A single-center retrospective observational study of critically ill patients aged 65 years or older was conducted. We extracted data from the dietitian evaluations on energy, protein, and the type of diet (fasting, oral, enteral, or parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. RESULTS: Of the 2043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68-78) years. Overall, the intrahospital mortality rate was 53.8%. Simplified Acute Physiology Score 3 (SAPS 3), serum albumin and C-reactive protein levels, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS 3, serum albumin level, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutrition prescription. CONCLUSION: Older adults (65 years or older) constitute a fragile population in whom nutrition breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population.