ABSTRACT
A cirurgia bariátrica continua a ser o tratamento mais efetivo para obesidade mórbida e a mais associada a outras condições metabólicas tais como diabetes tipo 2, doença refluxo gastroesofágico, e apneia do sono obstrutiva. Na população obesa, deficiências nutricionais comuns incluem vitaminas A, C, D, e B12, folato, tiamina, ferro, ferritina, zinco e selênio. Com a perda de peso ponderal, muitos pacientes podem utilizar o contorno corporal para deformidades. Após perda de peso ponderal seguida de cirurgia bariátrica, os pacientes geralmente desenvolvem deficiência nutricional significante que aumenta o risco de morbidade e mortalidade pós-operatória com quaisquer cirurgias subsequentes. Alguns pacientes requererem avaliação adicional durante a doença, ou quando candidatos eletivos pré-cirurgia, devido a alterações no trato alimentar com objetivo de melhorar os resultados e prevenir complicações devido a deficiências nutricionais.
Bariatric surgery continues to be the most effective treatment for morbid obesity and most other associated metabolic conditions such as type 2 diabetes mellitus, gastroesophageal reflux disease, and obstructive sleep apnea. In the obese population, common nutritional deficiencies include vitamins A, C, D, and B12, folate, thiamine, iron, ferritin, zinc, and selenium. With massive weight loss, many patients may utilize body contouring for deformities. After massive weight loss following bariatric surgery, patients often develop significant nutritional deficiencies that increase the risk of postoperative morbidity and mortality with any subsequent surgeries. Some unique patients will require additional evaluation during illness or when considering elective surgery due to alterations to the alimentary tract, in order to optimize outcomes and prevent complications from nutritional deficiencies.
Subject(s)
Humans , History, 21st Century , Postoperative Complications , Obesity, Morbid , Case Reports , Review Literature as Topic , Weight Loss , Morbidity , Mortality , Evaluation Study , Deficiency Diseases , Drug-Related Side Effects and Adverse Reactions , Bariatric Surgery , Nutritional Sciences , Obesity/pathology , Postoperative Complications/mortality , Obesity, Morbid/surgery , Obesity, Morbid/pathology , Deficiency Diseases/surgery , Deficiency Diseases/pathology , Drug-Related Side Effects and Adverse Reactions/surgery , Drug-Related Side Effects and Adverse Reactions/pathology , Bariatric Surgery/adverse effects , Bariatric Surgery/methods , Nutritional Sciences/methods , Obesity , Obesity/surgeryABSTRACT
Agewise agreement between mid-upper arm circumference (AC), weight for age and weight for height assessment of nutritional status was analyzed for 5,509 Indian children 1 to 5 years of age. Sensitivity specificity and positive predictive value of AC are presented. The sensitivity of AC for detecting moderate malnutrition by weight for age or weight for height was found to be low, except in children 13-24 months of age. From 25-58% of the severely malnourished children by weight for age in the age group 25-60 months were misclassified as normal by AC. Specificity of AC was high across the age range indicating that most of the children identified as not malnourished by weight for age or weight for height also had normal AC. The positive predictive value of AC was low for severe malnutrition but high for moderate to mild malnutrition compared to weight for age and weight for height. The findings indicate that AC is not constant over the age range 1 to 5 years, and use of fixed cut-off points for assessing malnutrition from 1 to 5 years is inappropriate. Sensitivity of AC using a fixed-cut-off point clearly decreases with age, and specificity increases with age. Where possible, weight of children is preferable to AC for nutritional status assessment, due to large number of moderately or severely malnourished children likely to be wrongly classified as normal by AC.