Calidad de vida en pacientes operadas de bypass gástrico hace más de un año: Influencia del nivel socioeconómico / Quality of life of patients subjected to gastric bypass more than one year ago: Influence of socioeconomic status

Background: The study of the effects of bariatric surgery on quality of life in patients of different socioeconomic levels (SEL) is worthwhile. Aim: To study quality of life (QoL), eating behavior, depressive symptoms and sexuality in patients subjected to a gastric bypass (GBP) more than 1 year before. Material and methods: The sample was composed of 33 GPB patients (19 high SEL and 14 low SEL), and 27 non-operated women (18 high SEL and 9 low SEL) of similar weight and age, as controls. Assessment included medical history anthropometry radiological densitometry. Eating behavior was assessed using the three factor eating questionnaire, quality of life using SF-36 and the Bariatric Analysis of Reporting Outcome System (BAROS) depressive symptoms were assessed using the Beck scale version II and sexual behavior using the female sexual function index (FSFI). Results: QoL was lower in operated patients from low SEL, especially when compared to high SEL control women. Operated patients had a predominantly restrictive pattern of eating behavior. Eating behavior disorders were detected in 5 of 33 operated patients versus 4 of 27 controls (p =ns). Sexual function was absent or dysfunctional in 22 operated versus 8 controls (p =0,02). No significant differences were observed for depressive symptoms, between operated patients and controls. Conclusions: In the long term, QoL of bariatric patients, especially those from low SEL, is inferior to control women and Chilean general population. Operated patients have restrictive eating patterns and lower sexual satisfaction indexes. Frequency of depressive symptoms was high both in bariatric and control women.

Evaluación a largo plazo del estado nutricional, composición corporal y densidad mineral ósea en mujeres operadas de bypass gástrico: impacto del nivel socioeconómico / Nutritional status, body composition and bone mineral density in gastric bypass females: impact of socioeconomic level

Background: Roux-en-Y gastric bypass (RYGBP) has had a positive impact on co-morbidities associated with obesity. However, in the long-term it can induce micronutrient deficiencies. Aim: To perform a complete nutritional assessment in a group of women previously operated of RYGBP, from different socioeconomic levéis (SEL). Patients and Methods: Thirty three women (19 high SEL and 14 low SEL), were assessed by dietary recalls, anthropometric measurements, muscle strength, bone mineral density, routine clinical laboratory, serum levéis of vitamin B12, 250H-vitamin D, Mate, calcium, ferritine, ceruloplasmin and indicators ofbone turnover (parathohormone, osteocalcin and urinary pyridinolines). Their valúes were compared to those of 30 control women (18 high SEL and 12 low SEL). Results: Low SEL operated women consumed fewer vitamin and mineral supplements compared with their high SEL pairs. No cases of vitamin B12, folie acid or copper deficiencies were detected. Frequency of iron deficieney was similar in patients and controls. Vitamin D insufficieney was higher amongpatients than in controls (p =0,04 7), regardless SEL. Patients had also a higher frequency of high serum PTH and osteocalcin and urinary pyridinoline levéis. However, no differences in bone mineral density were observed between operated women and controls. Conclusions: Vitamin and mineral deficiencies were lower than expected among operated women. However, problems associated with vitamin D deficieney were highly prevalent among patients operated of RYGBP, irrespective SEL. These alterations were only detectable through speciñe markers at this stage, because they did not transíate into lower bone mineral density (BMD) of surgicalpatients, probably due to the higher pre-operative BMD of these morbidobese patients.

Determinación de los índices glicémicos y de insulina en fórmulas para alimentación enteral en adultos sanos / Glycemic and insulin indices of tube feeding formulas in healthy adults

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients. Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product. Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial® (casein peptide based formula), Peptamen®, (whey peptide based formula), Glytrol® (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times. Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p <0.02) compared with the standard meal. The GI response did not appear to be due to enhanced insulin secretion. The other tested formulas had lower GI than the standard meal, but in addition they exhibited increased II The whey based peptide formulation produced the highest insulin response (p <0.03). Conclusions: Both GI and II are related to the concentration, form and type of protein contained in the enteral formula. The whey peptide formulation produced a low GI with the highest insulin index. Based on the low GI of these enteral products, all can be useful to provide nutritional support during metabolic stress, without adding an additional challenge to blood glucose management.

Evaluación biológica de un sustituto lácteo para el escolar, a base de harina de trigo cruda refinada, sometida a hidrólisis enzimática / Biological quality of a milk substitute for school children based on refined wheat flour subjected to enzimatic hydrolysis

Se realizó una evaluación biológica de un instituto lácteo experimental, a base de harina de trigo cruda refinada sometida a hidrólisis enzimática, en comparación a un producto testigo basado en harina extruída y proteína de leche. El trabajo utilizó 35 escolares de un internado, con una edad promedio de 8.6 más o menos 0.6 años. Las niñas fueron alimentadas con dieta habitual durante dos períodos consecutivos de 14 y 12 días cada uno, reemplazando en forma aleatoria, mediante un estudio doble ciego cruzado, el sustituto lácteo en ese momento en uso en la institución, por los sustitutos testigo y experimental. Se evaluó la absorción aparente de proteína, energía, calcio y fósforo. La ingestión nitrogenada promedio fue significativamente más baja con el sustituto experimental (223 vs. 244 mg/Kg/día, p<0.0001), lo que reflejo menor nitrógeno absorbido (187 vs. 203 mg/Kg/día, p<0.0001). La ingestión energética y la excreción fecal fueron similares con ambos sustituto, observándose un 96 por ciento y 95 por ciento de absorción con el producto experimental y testigo respectivamente. La ingestión promedio de calcio fue significativamente inferior con el sustituto experimental (39.7 vs. 60.2 mg/Kg/día, p<0.0001), y el calcio absorbido fue de un 50 por ciento en relación al obtenido con el sustituto testigo (20.7 vs. 39.5 mg/Kg/día, p<0.0001). La ingestión de fósforo fue significativamente menor con el producto experimental (22.0 vs. 27.8 mg/Kg/día) y lo absorbido fue 13.1 vs. 16.5 mg/Kg/día respectivamente. Con ambos sustitutos se obtuvo una buena tolerancia. Concluimos, que las voluntarias que ingirieron el producto a base de harina de trigo cruda refinada, no presentaron diferencias importantes en la digestibilidad de las proteínas y energía en relación al testigo; sin embargo, la absorción de calcio y fósforo fue significativamente inferior al consumir el producto experimental, lo cual limita su uso en los programas de alimentación escolar.