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3.
Surg Obes Relat Dis ; 7(2): 151-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20702143

RESUMO

BACKGROUND: We sought to identify the frequency and mechanisms of anemia after bariatric surgery in a bariatric surgery program at the Medical College of Wisconsin, (Milwaukee, WI). Anemia after bariatric surgery has often been attributed to iron deficiency, although an inflammatory component might be present, making the anemia after surgery mechanistically complex. METHODS: The body mass index and hemoglobin (Hb), vitamin B(12), folate, iron, and ferritin levels were extracted from the records of 1125 patients for ≤4 years after Roux-en-Y gastric bypass. Anemia was defined using the World Health Organization criteria. RESULTS: The mean body mass index, Hb, and ferritin decreased after surgery. The body mass index decreased from 50.1 kg/m(2) (95% confidence interval [CI] 49.6-50.6) at baseline to 33.0 kg/m(2) (95% CI 32.3-33.6) at 12 months and remained unchanged thereafter. The Hb level decreased from 13.4 g/dL (95% CI 13.3-13.5) to 12.8 (95% CI 12.6-13.1) and ferritin from 87.5 ng/mL (95% CI 75.2-99.7) to 55.4 (95% CI 42.9-68.0) at 24-48 months, and serum iron increased from 68.4 µg/dL (95% CI 66.8-70.0) to 82.8 (95% CI 76.4-88.7); all P values were <.01. Anemia was present in 12% (95% CI 10-14%) of patients at baseline and had increased to 23% (95% CI 16-30%) at 24-48 months. The changes in ferritin, Hb, and the percentage of patients with anemia were most pronounced in premenopausal women. Vitamin B(12) and folate levels were unaffected. CONCLUSION: The baseline incidence of anemia was greater than expected and increased significantly after surgery. The percentage of those with anemia and low ferritin was most significant in premenopausal women; however, the overall iron bioavailability improved significantly with pronounced weight loss, suggesting a reduction in inflammation. These findings indicate that anemia after bariatric surgery cannot be explained on the basis of iron availability and suggest that other mechanisms, currently undefined, contribute to the development of anemia in these patients.


Assuntos
Anemia/etiologia , Cirurgia Bariátrica/efeitos adversos , Ferritinas/sangue , Hemoglobinas/metabolismo , Ferro/sangue , Obesidade Mórbida/cirurgia , Vitamina B 12/sangue , Adulto , Anemia/sangue , Anemia/epidemiologia , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/etiologia , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Incidência , Masculino , Obesidade Mórbida/sangue , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Wisconsin/epidemiologia
4.
Nutr Clin Pract ; 24(2): 217-26, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19321896

RESUMO

Bariatric surgery for morbid obesity is rapidly gaining popularity. Restrictive and/or malabsorptive surgical interventions result in dramatic weight loss with significantly decreased obesity-related morbidity and mortality. Anemia, which may affect as many as two-thirds of these patients, is of concern and generally thought to be caused by iron deficiency. Although iron deficiency in this population may be frequent given pouch hypoacidity, defunctionalized small bowel, and red meat intolerance, it may not account for all anemias seen. First, there is increasing evidence that obesity creates a state of chronic inflammation. Both iron deficiency anemia and anemia of chronic inflammation present with low serum iron levels. Most studies reporting anemia after bariatric surgery lack serum ferritin determinations so that the relative contribution of inflammation to anemia cannot be assessed. Second, a significant number of anemias after bariatric surgery remain unexplained and may be attributable to less frequently seen micronutrient deficiencies such as copper, fatsoluble vitamins A and E, or an imbalance in zinc intake. Third, although deficiencies of folate and vitamin B(12) are infrequent, study observation periods may be too short to detect anemia attributable to vitamin B(12) deficiency because vitamin B(12) storage depletion takes many years. This review is intended to increase awareness of the mechanisms of anemia above and beyond iron deficiency in the bariatric patient and provide healthcare providers with tools for a more thoughtful approach to anemia in this patient population.


Assuntos
Anemia Ferropriva/epidemiologia , Cirurgia Bariátrica , Deficiências de Ferro , Síndromes de Malabsorção/etiologia , Obesidade Mórbida/cirurgia , Adulto , Anemia Ferropriva/etiologia , Cirurgia Bariátrica/efeitos adversos , Feminino , Heme/farmacocinética , Humanos , Inflamação/sangue , Ferro/sangue , Ferro da Dieta/farmacocinética , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/metabolismo , Deficiência de Vitamina B 12/etiologia , Deficiência de Vitamina B 12/metabolismo
5.
Nutr Clin Pract ; 20(6): 597-606, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16306296

RESUMO

Vascular access has become a key component for a multitude of IV therapies, including parenteral nutrition. Access of the central venous system has been long recognized for its associated complications of infection, thrombosis, and occlusion. Over the past 25 years, clinical practice based on research and innovation has attempted to decrease complication rates and therefore improve the safety of vascular access. This article highlights the research and its influence on catheter care procedures, technology, and education that has led to advances in vascular access. An improved understanding of the pathophysiology associated with catheter-related complications and an ongoing evaluation of new treatment modalities has provided clinicians today with new options for improved patient care and the ability to preserve vascular access options for patients.


Assuntos
Cateterismo Venoso Central/métodos , Infecções Bacterianas/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Constrição , Falha de Equipamento , Pessoal de Saúde/educação , Humanos , Trombose Venosa/complicações
6.
J Wound Ostomy Continence Nurs ; 32(6): 393-401, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16301906

RESUMO

In the United States, obesity has reached epidemic proportions. Serious medical complications, impaired quality of life, and premature mortality are all associated with obesity. Medical conditions such as type 2 diabetes mellitus, hypertension, hyperlipidemia, or sleep apnea can improve or be cured with weight loss. Medical treatment programs focused on diet, behavior modification, and/or pharmacologic intervention have met with limited long-term success. Although surgical treatments for obesity have become popular in recent years, they should only be used as a last resort for weight loss. Not all patients can be considered appropriate candidates for surgery; therefore, guidelines based on criteria from the National Institutes of Health should be used preoperatively to help identify suitable persons. Most individuals who opt for weight-loss surgery have usually struggled for many years with losing weight and keeping it off, but surgery alone will not ensure successful weight loss. Patient education is imperative for long-term success. Moreover, any such educational regimen should include information on diet, vitamin and mineral supplementation, and lifestyle changes, as well as expected weight-loss results and improvements in comorbid conditions. Patients must be willing to commit to a long-term follow-up program intended to promote successful weight loss and weight maintenance and to prevent metabolic and nutritional complications.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade Mórbida/cirurgia , Assistência ao Convalescente , Medicina Bariátrica/métodos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/mortalidade , Cirurgia Bariátrica/enfermagem , Terapia Comportamental , Índice de Massa Corporal , Comorbidade , Terapia por Exercício , Promoção da Saúde , Humanos , Estilo de Vida , Papel do Profissional de Enfermagem , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Seleção de Pacientes , Assistência Perioperatória/métodos , Assistência Perioperatória/enfermagem , Guias de Prática Clínica como Assunto , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Redução de Peso
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