Bariatric surgery affects obesity-related protein requirements.

CONTEXT: Following bariatric surgery, protein deficiency intakes are reported in morbidly obese patients, whereas post-bariatric protein requirements are not specifically defined with validated method in this population. OBJECTIVE: To assess average protein requirement (APR) in obese subjects, before, 3 months and 12 months after bariatric surgery using the validated method of nitrogen balance. DESIGN AND SETTING: Prospective longitudinal study conducted in 21 morbidly obese patients (BMI 43.9 ± 1.4 kg/m2) before (M0), 3 months (M3) and 12 months (M12) after sleeve gastrectomy or Roux-en-Y gastric by-pass. An additional larger cross-sectional study was performed to validate APR before surgery in non-operated matched obese patients (n = 106). APR was evaluated at M0, M3, M12 by measuring 3 days dietary intakes together with losses of nitrogen in urine and stools. MAIN OUTCOME MEASURE: APR was defined as the mean value of protein intake required to achieve balance nitrogen equilibrium. RESULTS: Before surgery, APR in morbidly obese patients was 0.76 [95%CI, 0.66-0.92] g/kg Body Weight (BW)/d in the experimental group, and 0.74 [0.70-0.80] g/kg BW/d in the validation group. APR was 0.62 [0.51-0.75] g/kg/d at M3 and 0.87 [0.75-0.98] g/kg/d at M12, with no difference between surgical procedures. Spontaneous protein intakes were respectively 0.80 ± 0.05, 0.43 ± 0.03 and 0.71 ± 0.04 g/kg BW/d respectively at M0, M3 and M12. CONCLUSION: This study demonstrates a temporal change in protein requirement after bariatric surgery whatever the type of surgery. Spontaneous protein intakes following bariatric surgery does not cover protein requirements for most patients, suggesting that specific dietary protein recommandations have to be adapted in obese patients with bariatric surgery. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01249326.

Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation.

Metabolic and structural changes in skeletal muscle that accompany obesity are often associated with the development of insulin resistance. The first events in the pathogenesis of this disorder are considered as an accumulation of lipids within skeletal muscle due to blunted muscle capacity to oxidize fatty acids. Fat infiltration is also associated with muscle fibre typology modification, decrease in muscle mass and impairments in muscle strength. Thus, as a result of obesity, mobility and quality of life are affected, and this is in part due to quantitative and qualitative impairments in skeletal muscle. In addition, the insulin resistance related to obesity results not only in defective insulin-stimulated glucose disposal but has also detrimental consequences on protein metabolism at the skeletal muscle level and whole-body level. This review highlights the involvement of fat accumulation and insulin resistance in metabolic disorders occurring in skeletal muscle during the development of obesity, and the impairments in the regulation of protein metabolism and protein turnover in the links between obesity, metabolic inflammation and insulin resistance.

[Do the patients medicate themselves correctly?]. / Se automedican correctamente los pacientes?

OBJECTIVE: To find the main pathologies which give rise to self-medication, the most commonly used pharmacological groups, how these drugs are obtained and the correctness of their instructions. DESIGN: Observation study of a crossover type. SETTING: An urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: 396 patients, who attended during the months of February and March 1993 with requests for medication or who were already taking something, were selected at random--95% Confidence Interval with 0.049 exactness. MEASUREMENTS AND MAIN RESULTS: 76% attended when they were already taking medication, a percentage which was significantly lower among elderly people (p < 0.001). The most common pharmacological groups were analgesics (32.6%), antibiotics (19.9%) and antiflu drugs (17.6%); and the most common pathologies were respiratory conditions with or without temperature (26.2% and 32.3% respectively). Self-medication was correct in 75.5% of cases. It was least correct for antibiotics and vitamins and in descriptions of asthenia, where, in turn, demand was more frequent than self-consumption (p < 0.001). The main reason for taking medication was its previous medical prescription (38.64%). CONCLUSIONS: Patients correctly use the commonest medicines used in primary care, especially if they have been prescribed before. This suggests the importance of daily health education for each prescription, especially for the most common pathologies.