ABSTRACT
Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.
Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.
Subject(s)
Female , Adult , Middle Aged , Vitamin D , Body Composition , Bone Diseases, Metabolic , Bone Density , Premenopause , Bariatric Surgery , Cross-Sectional StudiesABSTRACT
ABSTRACT: Study Design: Cross-sectional. Objective: Estimating the prevalence of hypovitaminosis D in a group of severely obese subjects referred to bariatric surgery. Methods: This study evaluated severely obese patients aged ≥18 years assisted by a specialized team in bariatric surgery. Clinical, anthropometric, and laboratory data were obtained from patient records. Plasma 25 (OH) D was determined by chemiluminescence and levels ≤ 20 ng/mL was considered as Hypovitaminosis D. The data were analyzed using the Statistical Package for Social Sciences® (SPSS) 20.0. Variables were described using descriptive statistics. For the comparison of the three groups, ANOVA, Kruskal-Wallis, and Pearson's chi-square tests were used. Spearman correlation test was performed to assess correlations between 25(OH)D and the other variables. P-values <0.05 were considered to be significant. Results: The study included 400 individuals, 71% were female with the mean age (SD) and BMI (SD) of 35.6 (9.1) years and 41.4 (5.1) kg/m², respectively. The vitamin D ranged from 4.5 to 62.4 ng/mL and the mean (SD) was 24.7 (7.9) ng/mL. In this sample, 117 (29.3%) individuals had hypovitaminosis D. There was a negative correlation between 25(OH)D and BMI (r= -0.110; p=0.028) and parathormone (r= -0.152; p=0.006) and positive correlation with serum calcium (r= 0.132; p=0.013) and phosphorus (r= 0.116; p=0.027). Conclusion: Severely obese subjects had a high prevalence of hypovitaminosis D even living in a sunny state. (AU)
RESUMO Modelo do estudo: Estudo transversal. Objetivo: estimar a prevalência da hipovitaminose D em um grupo de obesos graves encaminhados à cirurgia bariátrica. Métodos: Foram estudados obesos atendidos por uma equipe especializada em cirurgia bariátrica, com 18 anos ou mais de ambos os sexos. Dados clínicos, antropométricos e laboratoriais foram obtidos dos prontuários dos pacientes. A 25 (OH) D plasmática foi determinada por quimiolu-minescência e valores ≤20 ng/mL foram considerados como hipovitaminose D. Os dados foram analisados utilizan-do o Statistical Package for the Social Sciences® (SPSS) 20.0. Estatística descritiva foi utilizada para apresentação das variáveis e para comparação dos três grupos foram utilizados os testes: ANOVA, Kruskal-Wallis e qui-quadrado de Pearson. Foram considerados estatisticamente significantes valores de p<0,05. Resultados: Foram estudados 400 pacientes, 71% do sexo feminino, com média (DP) de idade e IMC 35,6 (9,1) anos e 41,4 (5,1) kg/m², respec-tivamente. A vitamina D variou de 4,5 a 62,4ng/mL com média (DP) de 24,7 (7,9) ng/mL. Na amostra, 117 (29.3%) dos pacientes apresentaram hipovitaminose D. Houve correlação negativa entre 25 (OH) D e IMC (r = -0,110; p = 0,028) e paratormônio (r = -0,152; p=0,006) e correlação positiva com cálcio sérico (r=0,132; p = 0,013) e fósforo (r=0,116; p=0,027). Conclusão: Os obesos graves apresentaram alta prevalência de hipovitaminose D, mesmo vivendo em um estado ensolarado.
Subject(s)
Humans , Male , Female , Adult , Avitaminosis , Vitamin D , Chi-Square Distribution , Prevalence , Bariatric Surgery , ObesityABSTRACT
A polysaccharide was extracted from the roots of Pombalia calceolaria, a plant used in folk medicine in Northeastern Brazil, by decoction followed by precipitation with methanol, yielding a concentration of 13.0% w/w, and purification with acetone. The molar mass peak was estimated to be 4.0×10(3)Da using gel permeation chromatography (GPC). Polarized light photomicrography of histological sections revealed the presence of inulin in the cortical parenchyma. The chemical composition of inulin was identified by 1D and 2D NMR and FT-IR spectroscopy and the findings were compared with the literature. This is the first time inulin has been identified on FT-IR and NMR for the species Pombalia calceolaria.
