Impact of marked weight loss induced by bariatric surgery on bone mineral density and remodeling

Data about the impact of bariatric surgery (BS) and subsequent weight loss on bone are limited. The objective of the present study was to determine bone mineral density (BMD), bone remodeling metabolites and hormones that influence bone trophism in premenopausal women submitted to BS 9.8 months, on average, before the study (OGg, N = 16). The data were compared to those obtained for women of normal weight (CG, N = 11) and for obese women (OG, N = 12). Eight patients in each group were monitored for one year, with the determination of BMD, of serum calcium, phosphorus, magnesium, parathyroid hormone, 25-hydroxyvitamin D, insulin-like growth factor-I (IGF-I) and osteocalcin, and of urinary calcium and deoxypyridinoline. The biochemical determinations were repeated every three months in the longitudinal study and BMD was measured at the end of the study. Parathyroid hormone levels were similar in the three groups. IGF-I levels (CG = 332 ± 62 vs OG = 230 ± 37 vs OGg = 128 ± 19 ng/mL) were significantly lower in the operated patients compared to the non-operated obese women. Only OGg patients presented a significant fall in BMD of 6.2 percent at L1-L4, of 10.2 percent in the femoral neck, and of 5.1 percent in the forearm. These results suggest that the weight loss induced by BS is associated with a significant loss of bone mass even at sites that are not influenced by weight overload, with hormonal factors such as IGF-I being associated with this process.

Environmental education praxis toward a natural conservation area

A non-formal Environmental Education (EE) Program has been implemented in the natural conservation area (Ecological Station of Jataí, Luiz Antônio, São Paulo State), through (EE) paradigms, which consider the objectives of education about, in and for the environment within cultural and natural perspectives. The aim of this Program is to support information and scientific knowledge to provide opportunities to the local population to be aware of environmental impacts and risks resulting from the soil use that threaten the environmental quality and the biodiversity of the Ecological Station of Jataí. The Program understands that the promotion of community empowerment could bring the sense of participation and the directives to management for decision-making for local sustainability. The model was projected on local reality, but considering the global issues of environmental paradigms. The environmental characterization (biophysical components) through a Geographical Information Systems was related to the hydrographic basin analysis. The environmental perception was utilized as a main tool to analyse population understanding of local environment, and (EE) pedagogical tools were produced to promote environmental awareness. Since the ecological dimension of (EE) was the main approach, the programme intends to assemble the cultural perspective, achieving the global view of (EE)

Anorexia nervosa: uma revisäo clínica de 12 casos / Anorexia nervosa: a clinical review of 12 cases

A anorexia nervosa é, fundamentalmente, um distúrbio do comportamento alimentar que se caracteriza pela abstençäo voluntária de alimentos, tendo como objetivo precípuo a perda progressiva de peso e o resultante emagrecimento. Compreende, sindromicamente, uma série de distúrbios psicológicos e comportamentais, a que se associam alteraçöes somáticas características das formas marasmáticas de desnutriçäo. Tem sido descrita, com ampla predominância, em adolescentes do sexo feminino, de classe sócio-econômica elevada, quase sempre em países desenvolvidos. Apresentamos, neste artigo, uma revisäo clínica de 12 casos de anorexia nervosa atendidos no Serviço de Nutrologia do HCFMRP-USP, cujos aspectos demográficos e de anamnese, sinais e sintomas, valores antropométricos e laboratoriais säo analisados e comparados com os critérios diagnósticos e perfis clínicos consagrados pela literatura. Considerando a progressiva incidência, alta morbidade e mortalidade da anorexia nervosa, preconizamos um melhor conhecimento das suas manifestaçöes clínicas entre nós, a fim de que o diagnóstico possa ser estabelecido o mais precocemente possível, facilitando o tratamento e favorecendo o prognóstico

Suporte nutricional a pacientes com câncer de cabeça e pescoço com dieta quimicamente definida por via enteral / Nutritional support to patients with head and neck cancer with chemically defined enteral feeding

A desnutriçäo protéico-enegética é um sério problema que se associa freqüentemente ao câncer e, particularmente, aos de cabeça e pescoço. No presente trabalho, descreve-se a evoluçäo clínico-nutricional de vinte pacientes com doença maligna da cabeça e pescoço que foram sumbmetidos a suporte nutricional enteral com dieta quimicamente definida (aminoácidos, sacarose, vitamina, eletrólitos e elementos traços). A duraçäo do suporte variou entre 12 133 dias, abrangendo o período de hospitalizaçäo para o tratamento cirúrgico. A avaliaçäo da eficiência do suporte foi realizada usando-se a variaçäo dos parâmetros antropométricos e laboratoriais. Os resultados observados demonstram uma média de ganho de pêso de 3.7kg. O ganho de peso que deveu, aparentemente, ao aumento de massa adiposa e massa muscular (prega triciptal: admissäo - 7.03 mm, alta 8.4 mm; circunferência muscular: admissäo - 21.85 cm, alta - 22.72 cm). Näo foram observadas diferenças significativas nos níveis de albumina sérica, capacidade total de ligaçäo ao ferro e contagem de linfócitos. Esses resultados evidenciam que o suporte nutricional agressivo a pacientes com câncer de cabeça e pescoço representa um instrumento terapêutico de valor no combate à desnutriçäo, especialmente no grupo submetido a cirurgias extensas