Riesgo cardiovascular, dislipemias e indicación de estatinas en una población de obesos mórbidos

Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados ​​478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.

Resultados cardiometabólicos de largo plazo tras cirugía bariátrica: control de comorbilidades, pérdida y reganancia de peso a los 5 años de seguimiento / Long-term cardiometabolic results after bariatric surgery: Control of comorbidities, weight loss and regain at 5 years of follow-up

Introducción. La cirugía bariátrica y metabólica (CBM) es efectiva en lograr pérdida de peso a corto plazo. Sin embargo, existe evidencia limitada en desenlaces clínicos y metabólicos a largo plazo. Métodos. Estudio longitudinal retrospectivo con pacientes llevados a baipás gástrico en Y de Roux (BGYR) o gastrectomía en manga (MG) por laparoscopia en Bogotá, D.C., Colombia, entre 2013 y 2021. El cambio de peso, control de comorbilidades y resultados metabólicos se recopilaron al inicio del estudio, 3, 6 y 12 meses después de cirugía, y anualmente hasta el quinto año. Las tasas de control de comorbilidades se evaluaron mediante la prueba Kaplan-Meier. Se utilizó un modelo de riesgos proporcionales de Cox para evaluar el efecto de covariables en la reganancia de peso. Resultados. De 1092 pacientes con CBM (71,4 % MG y 28,6 % BGYR), 67 % eran mujeres, con mediana de edad 48 años e índice de masa corporal de 35,5 Kg/m2. Después de cinco años de seguimiento, la tasa de control en diabetes mellitus fue 65,5 %, en hipertensión 56,6 % y en dislipidemia 43,6 %. La tasa de reganancia de peso fue 28 %, sin diferencias entre MG vs BGYR (p=0,482). El tiempo promedio hasta peso nadir fue 14 meses. La edad al momento de CBM fue el mejor predictor independiente de reganancia (HR=1,02, IC95% 1,01-1,04), pero con efecto clínico modesto. Conclusión. La CBM es segura y muestra beneficios a largo plazo en la pérdida de peso y control de comorbilidades en población colombiana.

Introduction. Bariatric and metabolic surgery (BMS) has shown its efficacy in achieving short-term weight loss. However, there is limited evidence regarding long-term clinical and metabolic outcomes. Methods. Retrospective longitudinal study with patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) interventions in Bogotá, Colombia, between 2013 and 2021. Weight change, comorbidity control, and metabolic outcomes were collected at the onset, 3-, 6-, and 12-month post-surgery, and annually up to the fifth year. Comorbidity control rates were assessed using the Kaplan-Meier test. A Cox proportional hazards model was used to evaluate the effect of covariates on weight regain. Results. Of 1092 patients with BMS (71.4% SG and 28.6% RYGB), 67% were women, with a median age of 48 years, BMI 35.5 kg/m2. After five years of follow-up, the control rate in diabetes mellitus was 65.5%, in hypertension 56.6%, and dyslipidemia 43.6%. The weight regain rate was 28% with no differences between SG vs RYGB (p=0.482). The mean time to nadir weight was 14 months. Age at the time of BMS was the best independent predictor of weight regain (HR=1.02, 95%CI: 1.01-1.04), but with a modest clinical effect. Conclusion. BMS is safe and shows long-term benefits in weight loss and control of comorbidities in Colombian population.

Revisión bibliográfica: cirugía bariátrica en adolescentes / Bibliographic review: bariatric surgery in adolescents

La obesidad en la infancia y adolescencia es un problema de salud mundial que ha ido en aumento, esto es preocupante no sólo por el riesgo de comorbilidades cardiovasculares, sino que también las psicosociales. La cirugía bariátrica se ha convertido en una alternativa para los casos de obesidad severa en adolescentes. Se trata de un método invasivo que requiere evaluación cuidadosa, no sólo en el aspecto físico, sino que también en el psicológico y social. El objetivo de este trabajo es conocer la evidencia disponible sobre las consecuencias que conlleva la cirugía bariátrica en adolescentes. Se realizó una búsqueda en la literatura en base de datos como PubMed, ScienceDirect y Scopus, utilizando palabras clave como "cirugía bariátrica", "obesidad en adolescentes", "efectos psicosociales" y "salud mental". Se han identificado diversos efectos negativos, entre los cuales destacan las deficiencias nutricionales que afectan al sistema nervioso central, los impactos en la salud mental y el riesgo de psicopatología. Sin embargo, la mayor cantidad de información e investigación se centra en los efectos positivos de la cirugía bariátrica. Aún faltan estudios en población adolescente, especialmente de carácter prospectivo y documentación de los posibles efectos negativos en la salud.

Obesity in childhood and adolescence is a global health problem that has been on the rise, and it is highly concerning due to the risk of cardiovascular and psychosocial comorbidities. Bariatric surgery has become an alternative for cases of severe obesity in adolescents. It is an invasive method that requires careful evaluation, not only in the physical aspect but also in the psychological and social aspects. The aim of this study is to understand the available evidence regarding the consequences of bariatric surgery in adolescents. A literature search was conducted in databases such as PubMed, ScienceDirect, and Scopus, using keywords such as "bariatric surgery," "obesity in adolescents", "psychosocial effects," and "mental health." Among the negative effects found, complications related to nutritional deficiencies affecting the central nervous system, effects on mental health, and the risk of psychopathology are evident. However, most of the information and research focus on the positive effects of bariatric surgery. There is a lack of studies in the adolescent population, especially those of a prospective nature, and documentation of potential negative health effects.

Mecanismos de pago en salud: resultados de ejecución del pago asociado a diagnóstico en cirugía bariátrica en su primer año de implementación en Chile / Healthcare payment mechanism: execution results of bundled payment program for bariatric surgery diagnosis in its first year of implementation in Chile

INTRODUCCIÓN: Más de 600 mil personas en Chile viven con obesidad mórbida. La incorporación de intervenciones terapéuticas eficaces, seguras y costo-efectivas es crítica para los sistemas de salud y esquemas de aseguramiento. En el año 2022 se incorporaron al arancel de modalidad de libre elección del Fondo Nacional de Salud dos códigos de pago asociado a diagnóstico para cirugía bariátrica: gástrico y manga gástrica. El objetivo fue caracterizar la ejecución del programa de mecanismo de pago tipo pago asociado a diagnóstico de cirugía bariátrica en su primer año de implementación. MÉTODOS: Estudio descriptivo y observacional de abordaje pragmático de la ejecución nacional del pago asociado a diagnóstico en cirugía bariátrica. Se examinaron variables de caracterización sociodemográfica (sexo, tramos etarios y tramos del Fondo nacional de Salud) y caracterización de cirugías según código desagregadas por prestador público o privado, periodo de emisión, gasto unitario, copago, y préstamos médicos, entre marzo y diciembre de 2022. RESULTADOS: Se registraron n = 13 118 cirugías (45,81% versus 54,19% manga), de las cuales n = 2424 (18,48%) emplearon préstamos médicos. Un 85,01% (p = 0,01) de los procedimientos fueron en mujeres; en personas entre 35 y 39 años (20,15%); y 45,12% en beneficiarios del tramo B. El 99,21% de las cirugías se realizó en prestadores privados. Diez de estos concentraron el 50% de la actividad (rango n = 1200 a 426 cirugías anuales; n = 4,8 a 1,7 cirugías por día hábil). El gasto total del programa fue $71 626 948 350 CLP, explicando un 5,04% de la actividad total del Programa nacional de Pago Asociado a Diagnóstico. CONCLUSIONES: La implementación de este bono para cirugía bariátrica benefició a más de 13 mil personas que viven con obesidad, mayormente mujeres, en edades productivas, y con capacidad de compra. Como estrategia de equidad, independientemente de la vía de acceso mediante el bono, será importante cautelar la actividad en la red pública.

INTRODUCTION: More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation. METHODS: Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022. RESULTS: We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program. CONCLUSIONS: The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.

Bariatric surgery: behavioral patterns and personality disorders in the preoperative period

Introduction: Bariatric surgery has become an increasingly common procedure, especially for patients with morbid obesity who have obtained unsatisfactory results from conventional treatments. Objective: To evaluate the occurrence of behavioral patterns and personality disorders in patients in the preoperative period of bariatric surgery. Materials and methods: Cross-sectional study carried out with 146 patients from a medium-sized clinic, a reference in the execution of bariatric surgeries in the Midwest region of Minas Gerais, Brazil. Data collection was performed using the psychological instrument entitled Factorial Personality Battery. Descriptive analysis and data association were performed. Results: Half of the participants presented high or very high scores for greater propensity to develop depression and anxiety, showing a close relationship with personality disorders, especially with behavioral patterns of effort and dedication. Discussion: The patterns of effort and dedication behavior are protective factors in the postoperative period, taking into account the adaptations and new habits necessary for a good recovery and maintenance of weight loss. Conclusions: The dysfunctional patterns of behavior that stood out most are related to greater difficulty in perceiving the positive side and ease in perceiving the negative side, leading to a more intense experience of suffering, in addition to difficulty in making decisions and facing routine challenges. Screening behavioral patterns and personality disorders preoperatively is necessary for adequate patient monitoring and successful bariatric surgery.

Recorriendo el camino hacia el éxito en cirugía bariátrica: el rol fundamental de la endoscopia bariátrica / Traversing the path to success in bariatric surgery: the fundamental role of bariatric endoscopy

RESUMEN La obesidad se ha convertido en una creciente epidemia de alcance global, exigiendo soluciones efectivas para su manejo. Actualmente, la cirugía bariátrica-metabólica es la mejor opción terapéutica en los pacientes con obesidad mórbida y comorbilidades asociadas. Este artículo de revisión aborda la importancia de la endoscopia en la evaluación pre y post operatoria, así como en la detección y manejo de las complicaciones asociadas a la cirugía bariátrica.

ABSTRACT Obesity has become a growing global epidemic, demanding effective solutions for its management. Bariatric-metabolic surgery is currently the best therapeutic option for patients with morbid obesity and associated comorbidities. This review article addresses the importance of endoscopy in the preoperative and postoperative evaluation, as well as in the detection and management of complications associated with bariatric surgery.

Early and severe onset of esophageal dysfunction after laparoscopic sleeve gastrectomy: a case report and review of literature / Inicio temprano y severo de disfunción esofágica después de manga gástrica laparoscópica: reporte de caso y revisión de la literatura

ABSTRACT After bariatric surgery one of the most common complications is dysphagia. The etiology of this disease has not been fully elucidated but it is known that it may be due to structural changes due to surgery. This case describes a 65-year-old female with early and severe onset of dysphagia following laparoscopic sleeve gastrectomy. The patient's final diagnosis was postobesity surgery esophageal dysfunction and laparoscopic proximal gastrectomy with esophagojejunal Roux-en-Y anastomosis was performed. Physicians should be aware of this condition in order to offer early diagnosis and treatment.

RESUMEN Después de una cirugía bariátrica una de las complicaciones más comunes es la disfagia. La etiología de esta enfermedad no ha sido completamente dilucidada, pero se sabe que puede deberse a cambios estructurales debidos a la cirugía. En este reporte se describe el caso de una mujer de 65 años con disfagia severa de aparición temprana después de una en manga gástrica laparoscópica. El diagnóstico final del paciente fue de una disfunción esofágica posterior a una cirugía de obesidad y se planteó como manejo una gastrectomía proximal laparoscópica con anastomosis esofagoyeyunal en Y de Roux. Hay que tener en cuenta las complicaciones a corto y largo plazo que se pueden presentar luego de cirugías de obesidad para poder realizar un diagnóstico temprano y poder ofrecer un tratamiento adecuado.

Effect of nalbuphine hydrochloride combined with dexmedetomidine on post-operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery / 实用医学杂志

Objective To investigate the effects of nalbuphine combined with dexmedetomidine on postop-erative recovery quality and pain in patients who undergoing laparoscopic bariatric surgery.Methods A total of 169 patients who underwent laparoscopic bariatric surgery at our hospital were included and divided into control group(group C),nalbuphine group(group N),dexmedetomidine group(group D),and nalbuphine combined with dexme-detomidine group(group ND)using randomised numerical table method.Group C received intravenous injection of saline,group N and group ND received intravenous injection of nalbuphine before the end of the surgery,and group D and group ND received pumping of dexmedetomidine before anesthesia induction and during surgery.Compare the postoperative recovery quality score(QoR-40),hemodynamics at different time points,visual analogue scale score(VAS),sedation-agitation scale(SAS),first time out of bed activity and exhaust time,and incidence of nausea and vomiting among four groups.Results The postoperative QoR-40 scores of patients in group ND were better than those in group C and group N(P<0.05),and the QoR-40 scores in group D were better than those in group C(P<0.05).MAP and HR were more stable during the awakening period in group ND and group D(P<0.05).Compared with group C,patients in all three groups had lower VAS scores and SAS scores(P<0.05)and consumed less remedial analgesic medication(P<0.05).In terms of adverse reactions,the incidence of postoperative nausea,vomiting and coughing in the group ND was lower than that in the group C(P<0.05).Conclusion The combination of nalbuphine and dexmedetomidine could improve the quality of postoperative recovery and pain in patients under-going laparoscopic bariatric surgery,reduce hemodynamic fluctuations during the patients′ recovery period,reduce the incidence of nausea and vomiting,and improve the patients′ prognosis.

Study on the application of different-length peripheral intravenous catheters in patients undergoing metabolic and bariatric surgery:a randomized clinical trial / 中华护理杂志

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81％,8.06％,and 58.06％.The extubation rates due to complications were 19.35％,4.84％,and 41.94％,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P＜0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P＜0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P＜0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.

Correlation of emotional abnormalities with the effectiveness of bariatric surgery in obese patients / 四川精神卫生

BackgroundBariatric surgery has emerged as an important tool in the management of obesity. Some patients undergoing bariatric surgery are prone to develop emotional abnormalities and have abnormally elevated concentrations of inflammatory factors level in peripheral blood， whereas current domestic research focusing on the impact of preoperative emotional states and peripheral blood inflammatory factors level on weight loss effect remains limited. ObjectiveTo explore the correlation of preoperative emotional abnormalities with the effectiveness of bariatric surgery in obese patients， and to provide theoretical basis for improving the clinical efficacy of bariatric surgery. MethodsEighty-one obese patients scheduled for bariatric surgery at gastrointestinal surgery Department of West China Hospital， Sichuan University from December 30， 2022 to June 30， 2023 were enrolled and assessed using Hamilton Depression Scale-17 item （HAMD-17） and Hamilton Anxiety Scale （HAMA）. Patients who scored 7 or above on HAMD-17 or HAMA or had a history of previous depression or anxiety diagnoses were classified into emotional abnormality group （n=34）， and samples who scored less than 7 on HAMD-17 and HAMA and were free of history of previous depression and anxiety diagnoses were set as non-emotional abnormality group （n=47）. The data were collected by the self made questionnaire. Patients were subjected to complete the assessment of Beck Scale for Suicide Ideation-Chinese Version （BSI-CV）， Eating Disorder Inventory （EDI） and Pittsburgh Sleep Quality Index （PSQI）. Laboratory tests including peripheral blood C-reactive protein （CRP） and interleukin-6 （IL-6）. Body weight and height assessed in the early morning after an overnight fasting period were recorded in all participants at 1- and 6-month after surgery through outpatient clinic visits or telephone follow-up. Pearson correlation coefficient was used to examine relationship among body mass index （BMI）， preoperative emotional states and peripheral blood inflammation mediators. ResultsAmong 81 obese patients， 62 completed the study， including 27 cases in emotional abnormality group and 35 cases in non-emotional abnormality group. Emotional abnormality group scored higher on BSI-CV （current）， BSI-CV （worst）， EDI and PSQI， and detected higher levels of CRP and IL-6 compared with non-emotional abnormality group （Z=2.677， 2.975， t=3.573， 4.035， 1.990， 2.799， P<0.05 or 0.01）. For BMI， there was no significant group effect and time×group interaction effect （P>0.05）， but a significant time effect （F=227.740， P<0.01）. Within emotional abnormality group， BMI at the baseline， 1- and 6-month after surgery showed a positive correlation with IL-6 level （r=0.419， 0.510， 0.559， P<0.05 or 0.01）， BMI at 6-month after surgery was positively correlated with HAMD-17 total score （r=0.390， P<0.05）， and ΔBMI% at 6-month after surgery was negatively correlated with HAMD-17 total score （r=-0.421， P<0.05）. Within non-emotional abnormality group， baseline BMI was positively correlated with IL-6 level （r=0.338， P<0.01）. ConclusionThe short-term effect of bariatric surgery may be comparable in obese patients with or without emotional abnormalities， while it cannot be ruled out whether the outcome of bariatric surgery is related to the severity of preoperative depression.

Impact of pre-operative weight loss on non-alcoholic fatty liver disease histopathology and insulin resistance in individuals undergoing bariatric surgery: a propensity matched cross-sectional comparison

ABSTRACT BACKGROUND: The effect of weight loss (WL) on histopathological aspects of non-alcoholic fatty liver disease (NAFLD) may provide further insights into the dynamics of hepatic recovery after WL. OBJECTIVE: To analyze the effects of pre-operative WL on insulin resistance- and NAFLD-related histology in individuals undergoing bariatric surgery (BS) with or without pre-operative WL. DESIGN AND SETTING: A matched cross-sectional study was conducted at a public university hospital and a private clinic in Campinas, Brazil. METHODS: An analytical, observational, cross-sectional study was conducted using prospectively collected databases of individuals who underwent BS and liver biopsy at either a public tertiary university hospital (with pre-operative WL) or a private clinic (without pre-operative WL). Random electronic matching by gender, age, and body mass index (BMI) was performed and two paired groups of 24 individuals each were selected. RESULTS: Of the 48 participants, 75% were female. The mean age was 37.4 ± 9.6. The mean BMI was 38.9 ± 2.6 kg/m2. Fibrosis was the most common histopathological abnormality (91.7%). Glucose was significantly lower in the WL group (92 ± 19.1 versus 111.8 ± 35.4 mg/dL; P = 0.02). Significantly lower frequencies of macrovesicular steatosis (58.3% versus 95.8%; P = 0.004), microvesicular steatosis (12.5% versus 87.5%; P < 0.001), and portal inflammation (50% versus 87.5%; P = 0.011) were observed in the WL group. CONCLUSION: Pre-operative WL was significantly associated with lower frequencies of macro- and mi- crovesicular steatosis, portal inflammation, and lower glycemia, indicating an association between the recent trajectory of body weight and histological aspects of NAFLD.

Histological findings and NAFLD/NASH Status in liver biopsies of patients subjected to bariatric surgery

ABSTRACT Objective: To investigate nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) and hepatic fibrosis in biopsies of people with obesity who underwent bariatric surgery and examine the possible association of different variables with a diagnosis of NAFLD and NASH. Materials and methods: Epidemiological, clinical and laboratory data from 574 individuals with obesity of both genders seen by the same physician between 2003 and 2009 who had a liver biopsy during bariatric surgery were examined. Results: Of the 437 patients included, 39.8% had some degree of liver fibrosis, 95% had a histologic diagnosis of NAFLD, and the risk factors were age ≥ 28 years and Homeostatic Model Assessment (HOMA) ≥ 2.5 (p = 0.001 and p = 0.016, respectively). In the NAFLD group, NASH was present in 26% of patients and the associated factors were aspartate aminotransferase and alanine aminotransferase index (AST/ALT) > 1, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, total cholesterol (TC) ≥ 200 mg/dL, gamma-glutamyl transferase (GGT) > 38 U/L and triglycerides (TG) levels > 150 mg/dL. The independent risk factors were low HDL-c, elevated AST/ALT and high TG. Conclusion: The variables associated with a diagnosis of NAFLD were HOMA ≥ 2.5 and age ≥ 28 years. NASH was associated with low HDL-c, high TG and AST/ALT ≤ 1.

Lo clásico y lo nuevo en el tratamiento del sobrepeso y la obesidad / The classic and the new in the treatment of overweight and obesity

Así como planteamos en la primera entrega de esta serie de artículos de actualización sobre la obesidad, resulta urgente revisar el abordaje tradicional que la comunidad médica le ofrece a las personas con cuerpos gordos. En este segundo artículo desarrollaremos en profundidad diferentes alternativas terapéuticas para los pacientes que desean bajar de peso:plan alimentario, actividad física, tratamiento farmacológico y cirugía metabólica. (AU)

As we proposed in the first issue of this series of articles, it is urgent to review the traditional approach that the medical community offers to people with fat bodies. This second article will develop different therapeutic alternatives for patients who want to lose weight: eating plans, physical activity, pharmacological treatment, and metabolic surgery. (AU)

Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass

ABSTRACT BACKGROUND: Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE: To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING: Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS: This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS: No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION: Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.

Effect of an oral health promotion program on gastroplasty patients: a randomized clinical trial / Efeito de um programa de promoção de saúde bucal em gastroplastizados: ensaio clínico randomizado

ABSTRACT BACKGROUND: Bariatric surgery can cause oral health problems in individuals, such as an increase in dental caries, periodontal diseases and dental erosion, which can be avoided if oral health promotion actions are implemented. AIMS: To assess the impact of an oral health promotion program implemented among gastroplasty patients. METHODS: This randomized clinical trial involved 208 patients undergoing gastroplasty; they were divided into two groups: Intervention Group, with participation in the Oral Health Promotion Program for Bariatric Patients, or Control Group. Assessments were carried out preoperatively, and six and 12 months postoperatively. The oral conditions assessed were: dental caries, periodontal diseases, tooth wear, dental plaque, and salivary flow. Sociodemographic information was obtained through application of structured questionnaires. For data analysis, the Chi-Square, Fisher's Exact, and Mann-Whitney tests were performed — α=5%. RESULTS: Patients in the Intervention Group, when compared to those in the Control Group, presented: fewer changes in enamel (6M: p<0.0001; 12M: p=0.001), in dentin (6M: p<0.0001; 12M: p<0.0001), moderate tooth wear (6M=0.002; 12M=0.005), gingival bleeding (6M: p<0.0001), dental calculus (6M=0.002; 12M: p=0.03), periodontal pocket 4-5 mm (6M=0.001; 12M: p=<0.0001); greater reduction in the bacterial plaque index (6M: p<0.0001; 12M: p<0.0001), and increased salivary flow (6M: p=0.019). CONCLUSIONS: The oral health promotion program had a positive impact on the prevention and control of the main problems to the oral health of the gastroplasty patients.

RESUMO RACIONAL: A cirurgia bariátrica pode ocasionar agravos bucais no indivíduo, como o aumento de cárie dentária, doença periodontal e erosão dentária, que podem ser evitados se ações de promoção em saúde bucal forem implementadas. OBJETIVO: Avaliar o impacto de um programa de promoção de saúde bucal implementado junto a gastroplastizados. MÉTODOS: Este ensaio clínico randomizado envolveu 208 pacientes submetidos à gastroplastia, divididos em dois grupos: Grupo de Intervenção, com participação no Programa de Promoção de Saúde Bucal para Pacientes Bariátricos ou Grupo Controle. As avaliações foram feitas no pré-operatório e pós-operatório de 6 e 12 meses. As condições bucais avaliadas foram: cárie dentária, doença periodontal, desgaste dentário, placa dentária e fluxo salivar. Informações sociodemográficas foram obtidas pela aplicação de questionários estruturados. Para análise dos dados foram aplicados os testes Qui- Quadrado, Exato de Fisher e Mann-Whitney, α=5%. RESULTADOS: Pacientes do Grupo de Intervenção, quando comparados aos do Grupo Controle, apresentaram: menos alterações de esmalte (6M: p<0,0001; 12M: p=0,001), de dentina (6M: p<0,0001; 12M: p<0,0001), desgaste dentário moderado (6M=0,002; 12M=0,005), sangramento gengival (6M: p<0,0001), cálculo dentário (6M=0,002; 12M: p=0,03), bolsa periodontal de 4-5 mm (6M=0,001; 12M: p=<0,0001); maior redução no índice de placa bacteriana (6M: p<0,0001; 12M: p<0,0001) e aumento do fluxo salivar (6M: p=0,019). CONCLUSÕES: Houve impacto positivo do programa de promoção de saúde bucal na prevenção e controle dos principais agravos à saúde bucal dos gastroplastizados.

Tradução e adaptação transcultural do questionário "Quality of Alimentation" para o português brasileiro / Translation and cross cultural adaptation of the questionnaire "Quality of Alimentation" for brazilian portuguese

RESUMO Objetivo Traduzir e adaptar transculturalmente o questionário "Quality of Alimentation" do inglês para a língua portuguesa do Brasil. Método O processo de tradução e adaptação transcultural do questionário "Quality of Alimentation" segue as seguintes etapas: tradução por dois tradutores bilíngues nativos do idioma alvo, síntese das versões e retradução por dois tradutores nativos do idioma de origem e, por fim, revisão da retradução para submissão a um comitê de juízes especialistas. Uma vez aprovado, o questionário seguiu para teste com usuários a fim de avaliar a clareza, compreensibilidade e aceitabilidade da versão traduzida. Resultados Na versão final em português brasileiro do questionário "Quality of Alimentation" o instrumento mostrou-se de claro entendimento e fácil aplicabilidade. Conclusão O questionário traduzido e adaptado para o português brasileiro, representa um passo significativo para melhora na avaliação da intolerância alimentar pós cirurgia bariátrica. Novos estudos são necessários para a validação das propriedades psicométricas do instrumento no Brasil.

ABSTRACT Purpose We aimed to provide translation and cultural adaptation of the questionnaire "Quality of Alimentation" from English to Brazilian Portuguese. Methods The transcultural translation process consisted of the following steps: translation of the original English version to Portuguese by two bilingual translators native in the targeted language; Reverse translation by two translators native in the original language; Review of reverse translation; Review of the Portuguese version from the questionnaire by a local committee of experts in bariatric surgery; Pre-trial to evaluate of clarity, comprehension, and overall acceptability by the target population. Results In its final Portuguese version, the questionnaire "Quality of alimentation" was found to be of clear comprehension and easy applicability. Conclusion The questionnaire's translation and cultural adaptation for Brazilian Portuguese represents an important step towards improving food tolerance evaluation following bariatric surgery. Further studies are however necessary for validation of its psychometric properties in Brazil.

Cirurgias bariátricas no sistema único de saúde no período de 2012 a 2022: estudo descritivo das hospitalizações no Paraná / Bariatric surgeries in the brazilian public health system from 2012 to 2022: descriptive study of hospitalizations in the state of paraná

ABSTRACT Background: Obesity is a chronic health condition with a multifactorial etiology, resulting from the interplay of genetic, environmental, and behavioral factors leading to an energy imbalance. Objective: To characterize hospitalizations for bariatric surgeries through the Brazilian Unified Health System (SUS) in the state of Paraná from 2012 to 2022. Methods: This is a descriptive and retrospective study, utilizing a time series design, based on secondary data. Public data from the SUS Hospital Information System for the period from 2012 to 2022 were consulted, focusing on the population of obese patients undergoing bariatric surgery. Results: In Paraná, concerning SUS procedures data from 2012 to 2022, 39,793 hospitalizations for bariatric surgeries were observed. Among the five modalities, Roux-en-Y gastric bypass predominated with 38,849 hospitalizations (97.6%), showing a lower mortality rate. Conclusion: The research highlights a notable variation in costs, emphasizing the importance of economic evaluation. The correlation between obesity and diabetes underscores the complexity of the situation, justifying the superiority of surgical treatment in comorbidity remission. The study reveals a decline in bariatric surgeries in 2020, coinciding with the pandemic, and alerts to the increased vulnerability of obese patients to SARS-CoV-2.

RESUMO Contexto: A obesidade é uma condição crônica de saúde que apresenta etiologia multifatorial. Resulta da combinação de fatores genéticos, ambientais e comportamentais, os quais, quando interagem, levam a um desbalanço energético. Objetivo: Caracterizar as hospitalizações pelo Sistema Único de Saúde (SUS) para realização de cirurgias bariátricas no estado do Paraná, no período de 2012 a 2022. Métodos: Trata-se de um estudo descritivo e retrospectivo, do tipo série temporal, baseado em dados secundários. Foram consultados os dados públicos contidos no sistema de informações hospitalares do SUS, no período de 2012 a 2022. A população analisada foram pacientes obesos submetidos à cirurgia bariátrica. Resultados: No Paraná, com relação aos dados de procedimentos realizados no SUS, no período de 2012 a 2022, foram observadas 39.793 hospitalizações para a realização de cirurgias bariátricas. Dentre as cinco modalidades, houve predomínio da gastroplastia em Y de Roux, com 38.849 hospitalizações (97,6%), com menor taxa de mortalidade. Conclusão: A pesquisa ressalta uma notável variação nos custos, enfatizando a importância da avaliação econômica. A correlação entre obesidade e diabetes evidencia a complexidade da situação, justificando a superioridade do tratamento cirúrgico na remissão de comorbidades. O estudo mostra uma queda nas cirurgias bariátricas em 2020, coincidindo com a pandemia, e alerta para a maior vulnerabilidade de pacientes obesos ao SARS-CoV-2.

Clinical-epidemiological assessment of patients undergoing bariatric and metabolic surgery in a medium-complexity service in Maranhão, Brazil / Avaliação clínico-epidemiológica de pacientes submetidos à cirurgia bariátrica e metabólica em um serviço de média complexidade no Maranhão

ABSTRACT Introduction: the obesity is defined as the excessive accumulation of fat in different areas of the body, a condition that causes damage to health and is a critical risk factor for various comorbidities. Bariatric surgery is the therapeutic option with the best results. Methods: this is a retrospective descriptive study using data obtained from medical records from January 2018 to December 2020 on patients undergoing bariatric surgery. Statistical analysis used a significance level of p<0.05. Results: 178 medical records were included, 77.5% of which were women. The average age was 35.7 years (± 9.5), 63.8% of the patients were from Imperatriz, 98.3% reported a sedentary lifestyle, 38.7% regular alcohol consumption and 13% smoking. The prevalence of Class III obesity (BMI≥40 kg/m²) was 53.3%. The most common comorbidities were hepatic steatosis (64.6%), type 2 diabetes mellitus (DM2) (40.5%) and hypertension (38.7%). The main type of surgery performed was Roux-en-Y gastric bypass (RYGB) (89.3%). There was an association between median BMI and gender (p=0.008), with women showing higher values [43.4 (IQR 39.1 - 48.8)]. The mean BMI of patients who underwent RYGB was significantly higher compared to those who underwent vertical gastrectomy (VG) (p=0.009). There was a statistical association between DM2 (p=0.033) and depression (p=0.018) and the type of surgery performed. Conclusion: the clinical and epidemiological profile found showed a higher prevalence of females and individuals with Class III obesity. RYGB was the most commonly performed procedure, establishing an association with BMI and some of the patients' comorbidities.

RESUMO Introdução: a obesidade é definida pelo acúmulo excessivo de gordura em diferentes regiões corporais, condição que acarreta prejuízos à saúde e constitui fator de risco para diversas comorbidades. A cirurgia bariátrica é a opção terapêutica com melhores resultados para o seu tratamento. Métodos: estudo retrospectivo descritivo realizado com dados obtidos de prontuários médicos do período de janeiro/2018 a dezembro/2020, relacionados a pacientes submetidos à cirurgia bariátrica. As análises estatísticas realizadas adotaram nível de significância p<0,05. Resultados: foram incluídos 178 prontuários, sendo 77,5% de mulheres. A média de idade foi de 35,7 anos (± 9,5), 63,8% dos pacientes eram procedentes de Imperatriz, 98,3% relataram sedentarismo, 38,7% consumo regular de álcool e 13% tabagismo. A prevalência de obesidade grau III (IMC≥40 kg/m²) foi de 53,3%. As comorbidades mais relacionadas foram esteatose hepática (64,6%), diabetes mellitus tipo 2 (DM2) (40,5%) e hipertensão arterial (38,7%). O principal tipo de cirurgia realizada foi o by-pass gástrico em Y de Roux (BGYR) (89,3%). Observou-se associação entre a mediana de IMC e o sexo (p=0,008), com as mulheres apresentando maiores valores [43,4 (IIQ 39,1 - 48,8)]. A média de IMC dos pacientes submetidos ao BGYR foi significativamente maior comparado aos que realizaram gastrectomia vertical (GV) (p=0,009). Houve associação estatística entre o DM2 (p=0,033) e a depressão (p=0,018) com o tipo de cirurgia realizada. Conclusão: o perfil clínico-epidemiológico encontrado evidenciou maior prevalência do sexo feminino e de indivíduos com obesidade grau III. O BGYR foi o procedimento mais realizado, estabelecendo associação com IMC e algumas comorbidades apresentadas pelos pacientes.

Anestesia libre de opioides en cirugía bariátrica laparoscópica

Introducción: La anestesia libre de opioides surge de las alternativas farmacológicas que permiten otra opción anestésica en el arsenal del anestesiólogo. Objetivo: Evaluar la efectividad y seguridad de una técnica anestésica libre de opioides en el paciente intervenido con cirugía bariátrica laparoscópica. Métodos: Se realizó un estudio observacional analítico, prospectivo y longitudinal en 23 pacientes operados con anestesia general multimodal libre de opioides. Pacientes mayores de 18 años con un índice de masa corporal mayor o igual a 35 kg/m2, con estado físico ASA II y III. Se evaluó la analgesia posoperatoria e intraoperatoria como una necesidad de la analgesia de rescate en el tiempo de recuperación y los efectos adversos. Resultados: Se demostró que la edad promedio fue 38,19 ± 8,73 con un predominio en el sexo femenino, los pacientes fueron clasificados como ASA II y obesos grados III. Hubo una estabilidad hemodinámica intraoperatoria. El 82,6 % de los pacientes no presentaron dolor posoperatorio en las primeras 24 h. No se presentaron pacientes con dolor severo. Requirieron analgesia de rescate cinco pacientes (21,7 %) en posoperatorio, y las complicaciones fueron escasas sin repercusión clínica. El tiempo promedio para la extubación fue de 6,7 ± 0,8 min y la recuperación total de 29,6 ± 0,8 min. Conclusiones: La técnica multimodal libre de opioides resultó segura y efectiva, con un adecuado estado de analgesia perioperatoria y escasas complicaciones en los pacientes intervenido con cirugía bariátrica laparoscópica.

Introduction: Opioid-free anesthesia arises from pharmacological alternatives that allow another anesthetic option in the anesthesiologist's arsenal. Objective: To evaluate the effectiveness and safety of an opioid-free anesthetic technique in patients undergoing laparoscopic bariatric surgery. Methods: An analytical, prospective and longitudinal observational study was carried out in 23 patients operated on with opioid-free multimodal general anesthesia. The patients studied were over 18 years of age, with a body mass index greater than or equal to 35 kg/m2, ASA physical status II and III. Postoperative and intraoperative analgesia were evaluated as a need for rescue analgesia in recovery time and adverse effects. Results: It was shown that the average age was 38.19 ± 8.73 with a predominance in the female sex, the patients were classified as ASA II and grade III obese. There was intraoperative hemodynamic stability. 82.6% of patients did not experience postoperative pain in the first 24 hours. There were no patients with severe pain. Five patients (21.7%) required rescue analgesia postoperatively, and complications were rare without clinical repercussions. The average time for extubation was 6.7 ± 0.8 min and total recovery was 29.6 ± 0.8 min. Conclusions: The opioid-free multimodal technique was safe and effective, with adequate state of perioperative analgesia and few complications in patients undergoing laparoscopic bariatric surgery.

Avaliação da gravidade dos sinais e sintomas da COVID-19 em pacientes submetidos à cirurgia bariátrica / Assessment of the severity of signs and symptoms of COVID-19 in patients undergoing bariatric surgery / Evaluación de la gravedad de los signos y sintomas de COVID-19 em pacientes sometidos a cirurgía bariátrica

Objetivo: Avaliar a gravidade e a incidência dos sinais e sintomas da COVID-19 em pacientes bariátricos, relacionando-os ao índice de massa corporal (IMC) e a outros fatores considerados de risco para a doença.Método: trata-se de um estudo transversal. Os pacientes responderam a um questionário eletrônico e a avaliação da gravidade dos sinais e sintomas da infecção por SARS-CoV-2 foi realizada seguindo o manual "Orientações para manejo de pacientes com covid-19", do Ministério de Saúde do Brasil. Resultados: um total de 60 pacientes foram incluídos. Dos participantes, 60% apresentaram sintomas graves e a fadiga foi o sintoma mais frequente (90%). A análise mostrou uma associação significativa entre a presença de tosse e a condição de sobrepeso/obesidade (OR=3,720; IC=1,060­13,050; p=0,034). Além disso, apenas 6,7% foram hospitalizados, sem casos de intubação, todos com sobrepeso/obesidade (OR=1,333; IC=1,114­1,554). Conclusão:apesar de uma alta taxa de pacientes categorizados com sinais e sintomas graves, verificou-se uma baixa necessidade de internação hospitalar e ventilação mecânica não invasiva. Isso sugere que a perda de peso e a melhora das comorbidades pós-cirurgia podem contribuir para um risco reduzido de hospitalização em casos de infecção por COVID-19

Objective: To assess the severity and incidence of COVID-19 signs and symptoms in bariatric patients, relating them to body mass index (BMI) and other risk factors for the disease. Method:This is a cross-sectional study. Patients completed an electronic questionnaire, and the severity of SARS-CoV-2 infection signs and symptoms was assessed following the "Guidelines for the management of COVID-19 patients" by the Brazilian Ministry of Health. Results:A total of 60 patients were included. Among the participants, 60% presented with severe symptoms, with fatigue being the most frequent symptom (90%). The analysis showed a significant association between the presence of cough and the condition of overweight/obesity (OR=3.720; CI=1.060­13.050; p=0.034). Moreover, only 6.7% were hospitalized, with no cases requiring intubation, all within the overweight/obesity subgroup (OR=1.333; CI=1.114­1.554).Conclusion: Despite a high rate of patients categorized with severe signs and symptoms, there was a low need for hospital admission and non-invasive mechanical ventilation. This suggests that weight loss and improvement of comorbidities post-surgery may contribute to a reduced risk of hospitalization in COVID-19 infection case.

Objetivo: Evaluar la gravedad y la incidencia de los signos y síntomas de COVID-19 en pacientes bariátricos, relacionándolos con el índice de masa corporal (IMC) y otros factores de riesgo para la enfermedad. Metodo:Se trata de un estudio transversal. Los pacientescompletaron un cuestionario electrónico, y la gravedad de los signos y síntomas de la infección por SARS-CoV-2 se evaluó siguiendo las "Guías para el manejo de pacientes con COVID-19" del Ministerio de Salud de Brasil. Resultados:Se incluyó un total de 60 pacientes. Entre los participantes, el 60% presentó síntomas severos, siendo la fatiga el síntoma más frecuente (90%). El análisis mostró una asociación significativa entre la presencia de tos y la condición de sobrepeso/obesidad (OR=3.720; IC=1.060­13.050; p=0.034). Además, solo el 6.7% fueron hospitalizados, sin casos que requirieran intubación, todos dentro del subgrupo de sobrepeso/obesidad (OR=1.333; IC=1.114­1.554). Conclusión:A pesar de una alta tasa de pacientes clasificados con signos y síntomasseveros, hubo una baja necesidad de admisión hospitalaria y ventilación mecánica no invasiva. Esto sugiere que la pérdida de peso y la mejora de las comorbilidades postoperatorias pueden contribuir a un riesgo reducido de hospitalización en casos de infección por COVID-19