Biliopancreatic diversion for severe obesity: long-term weight maintenance and occurrence of nutritional complications are two facets of the same coin.

BACKGROUND: Despite the widespread clinical use of hypoabsorptive metabolic bariatric surgery, very long-term outcomes are still lacking. The aim of the study was to assess the long-term safety and efficacy of biliopancreatic diversion at 30 years in patients with class 3 obesity (BMI over 40 kg/m2). METHODS: This retrospective single-centre study used data from a prospectively collected database on a sample of consecutive patients submitted to biliopancreatic diversion with a minimum follow-up of 30 years. Outcomes assessed included overall survival, long-term weight loss and weight maintenance, remission of obesity-related co-morbidities, and short- and long-term surgical and/or nutritional or metabolic complications. RESULTS: Among 199 consecutive patients (136 female, 63 male) who had surgery between November 1992 and April 1994, the mean age at operation was 38 (range 14-69) years and mean preoperative BMI was 48.7 (32.0-74.3) kg/m2. At baseline, 91 of 199 patients (45.7%) had type 2 diabetes. At 20 and 30 years, 122 (61%) and 38 (19%) of the 199 patients respectively were available for follow-up. At 30 years, the overall mortality rate was 12% (23 of 199). Surgical complications were concentrated in the short-term follow-up, whereas nutritional or metabolic complications increased progressively over time. A nutritional complication was diagnosed in 73 of 122 patients (60%) at 20 years and 28 of 38 (74%) at 30 years. Weight loss and glycaemic control were maintained throughout the follow-up; mean % total weight loss was 32.8 (range 14.1-50.0) at 1 year and 37.7 (range 16.7-64.8) at 30 years. One patient presented with recurrence of type 2 diabetes at 20 and 30 years; there were no patients with new-onset type 2 diabetes. CONCLUSION: Biliopancreatic diversion leads to good and sustained weight maintenance up to 30 years with low perioperative risk, but at the cost of a high long-term prevalence of nutritional complications.

Papel do gosto e do cheiro no controle do comportamento alimentar de ratos privados e näo privados / Effects of taste and smell in control of food behavior in privated and non privated rats

Neste experimento utilizou-se como sujeitos 24 ratos wistar que foram divididos em 4 grupos: näo-privados e privados de 25,50 e 75% da quantidade de raçäo diariamente, com 6 sujeitos em cada grupo. Os ratos receberam diariamente, durante 20 min, uma proveta contendo "leite condensado". Durante as 5 sessöes de linha de base registrou-se a quantidade de soluçäo ingerida pelos sujeitos dos 4 grupos. Na sexta sessäo administrou-se tetracaína (anestésico tópico) na boca e no nariz de todos os ratos e mediu-se a ingestäo de "leite condensado". Os resultados mostraram que o consumo de soluçäo do grupo controle caiu 50% em relaçäo à linha de base. Nos grupos privados, a supressäo da ingestäo parece ter sido dependente do grau de privaçäo a que os ratos foram submetidos. Mas o grupo privado de 75% de raçäo diariamente näo apresentou nenhuma reduçäo da ingestäo. Isso sugere que sob uma condiçäo de privaçäo severa, os efeitos do gosto e do cheiro exercem pouco ou nenhum controle sobre o comportamento alimentar. Esses resultados sugerem que o comportamento alimentar pode ser mediado por mecanismos regulatórios e hedônicos. Esses últimos parecem estar ausentes no caso de uma privaçäo severa