RESUMO
BACKGROUND: The effects of gastric bypass (GBP) on resting energy expenditure (REE) are not well known. AIM: To evaluate the changes in REE and its relationship with body composition in severe and morbid obese women before and six and twelve months after GBP. PATIENTS AND METHODS: Twenty three women aged 37+/-10 years, with a body mass index of 44+/-4 kg/m(2), were evaluated before, six and twelve months after GBP. REE was measured in a Deltatrac indirect calorimeter and expressed as kcal/day Fat mass (EM), and fat free mass (EEM) were determined by double beam X-ray densitometry (DEXA). RESULTS: Body weight reduction six and twelve months after GBP was 29.0+/-4.3 and 35.8+/-6.9%, respectively. The best predictor of weight reduction was initial weight (p <0.01). At six and twelve months, REE decreased by 291.7+/-260.0 and 353.8+/-378.4 kcal/day, respectively. In the same periods REE/kg body weight increased by 3.3 and 4.8 kcal/kg respectively, compared to baseline. REE/kg EEM was unchanged. CONCLUSIONS: GBP was associated with significant changes in body composition after six and twelve months. However, despite weight reduction, resting energy expenditure per fat free mass unit did not change significantly.
Assuntos
Metabolismo Basal/fisiologia , Composição Corporal/fisiologia , Derivação Gástrica , Obesidade Mórbida/metabolismo , Adulto , Ingestão de Energia/fisiologia , Feminino , Derivação Gástrica/métodos , Humanos , Obesidade Mórbida/cirurgia , Cuidados Pós-Operatórios , Fatores de Tempo , Redução de Peso/fisiologiaRESUMO
BACKGROUND: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). AIM: To assess the results of this program. PATIENTS AND METHODS: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m(2) and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. RESULTS: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m(2) was observed in 69% and 52% of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24% and 6% respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28% and 9% respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61% and 19% respectively, a plasma insulin equal to or greater than 12,5 microUl/ml was observed in 49% and 34% respectively and a HOMA equal to or greater than 2.5 was observed in 63% and 42% respectively (all these comparisons are significant with a p <0.05). CONCLUSIONS: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels and HOMA index.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde , Obesidade/terapia , Adolescente , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Chile/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Recusa do Paciente ao TratamentoRESUMO
The effects of gastric bypass (GBP) on resting energy expenditure (REE) are not well known. Aim: To evaluate the changes in REE and its relationship with body composition in severe and morbid obese women before and six and twelve months after GBP. Patients and methods: Twenty three women aged 37±10 years, with a body mass index of 44±4 kg/m², were evaluated before, six and twelve months after GBP. REE was measured in a Deltatrac indirect calorimeter and expressed as kcal/day Fat mass (EM), and fat free mass (EEM) were determined by double beam Xray densitometry (DEXA). Results: Body weight reduction six and twelve months after GBP was 29.0±4.3 and 35.8±6.9 percent, respectively. The best predictor of weight reduction was initial weight (p <0.01). At six and twelve months, REE decreased by 291.7±260.0 and 353.8±378.4 kcal/day, respectively. In the same periods REE/kg body weight increased by 3.3 and 4.8 kcal/kg respectively, compared to baseline. REE/kg EEM was unchanged. Conclusions: GBP was associated with significant changes in body composition after six and twelve months. However, despite weight reduction, resting energy expenditure per fat free mass unit did not change significantly.
Assuntos
Adulto , Feminino , Humanos , Metabolismo Basal/fisiologia , Composição Corporal/fisiologia , Derivação Gástrica , Obesidade Mórbida/metabolismo , Ingestão de Energia/fisiologia , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Cuidados Pós-Operatórios , Fatores de Tempo , Redução de Peso/fisiologiaRESUMO
Background: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). Aim To assess the results of this program. Patients and methods: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m² and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. Results: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m² was observed in 69 percent and 52 percent of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24 percent and 6 percent respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28 percent and 9 percent respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61 percent and 19 percent respectively, a plasma insulin equal to or greater than 12,5 fi Ul/rnl was observed in 49 percent and 34 percent respectively and a HOMA equal to or greater than 2.5 was observed in 63 percent and 42 percent respectively (all these comparisons are significant with a p <0.05). Conclusions: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels...
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /prevenção & controle , Promoção da Saúde , Obesidade/terapia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Chile/epidemiologia , /complicações , /diagnóstico , Métodos Epidemiológicos , Obesidade/complicações , Obesidade/epidemiologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Recusa do Paciente ao TratamentoRESUMO
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.