Cholesterol transfer to high-density lipoprotein in obesity and the effects of weight loss after bariatric surgery.

Obesity increases serum triglycerides and decreases high-density lipoprotein cholesterol (HDL-C). The objective is to explore some functions of HDL, cholesterol transfers and antioxidant, in subjects with grade I (G1-OB) and III (G3-OB) obesity and effects of bariatric surgery on G3-OB. Fifteen G3-OB patients (43 ± 6 years, BMI 49 ± 3 kg/m2) were studied before and 1 year after bariatric surgery; 15 G1-OB (32 ± 2 years, 32 ± 2 kg/m2) and 15 normal weight (NW) (38 ± 6 years, 22 ± 1 kg/m2) were also studied. HDL diameter, cholesterol transfer to HDL and antioxidant capacity of HDL were determined. G3-OB had higher triglycerides and lower HDL-C; G1-OB had higher triglycerides than NW but HDL-C was equal. Compared to NW, HDL size was smaller in G3-OB but equal in G1-OB. One year after bariatric surgery, BMI and triglycerides of G3-OB decreased (p < .0001 and p = .0012, respectively) and HDL-C increased (p < .0001), equalling of NW group. Antioxidant capacity and cholesterol transfers were not different in groups and were unchanged 1 year after bariatric surgery in G3-OB. HDL antioxidant capacity and transfer of cholesterol to HDL were not defective in obesity despite HDL-C reduction and smaller HDL size. In addition, pronounced weight loss by bariatric surgery did not change those protective functions.

Endoscopic transoral outlet reduction induces enterohormonal changes in patients with weight regain after Roux-en-Y gastric bypass.

Background and study aims Transoral outlet reduction (TORe) has long been employed in treating weight regain after Roux-en-Y gastric bypass. However, its impact on gut hormones and their relationship with weight loss remains unknown. Patients and methods This was a substudy of a previous randomized clinical trial. Adults with significant weight regain and dilated gastrojejunostomy underwent TORe with argon plasma coagulation (APC) alone or APC plus endoscopic suturing (APC-suture). Serum levels of ghrelin, GLP-1, and PYY were assessed at fasting, 30, 60, 90, and 120 minutes after a standardized liquid meal. Results were compared according to allocation group, clinical success, and history of cholecystectomy. Results Thirty-six patients (19 APC vs. 17 APC-suture) were enrolled. There were no significant baseline differences between groups. In all analyses, the typical postprandial decrease in ghrelin levels was delayed by 30 minutes, but no other changes were noted. GLP-1 levels significantly decreased at 12 months in both allocation groups. Similar findings were noted after dividing groups according to the history of cholecystectomy and clinical success. The APC cohort presented an increase in PYY levels at 90 minutes, while the APC-suture group did not. Naïve patients had significantly lower PYY levels at baseline ( P = 0.01) compared with cholecystectomized individuals. This latter group experienced a significant increase in area under the curve (AUC) for PYY levels, while naïve patients did not, leading to a higher AUC at 12 months ( P = 0.0001). Conclusions TORe interferes with the dynamics of gut hormones. APC triggers a more pronounced enteroendocrine response than APC-suture, especially in cholecystectomized patients.

Ecological and social factors influence interspecific pathogens occurrence among bees.

The interspecific transmission of pathogens can occur frequently in the environment. Among wild bees, the main spillover cases are caused by pathogens associated with Apis mellifera, whose colonies can act as reservoirs. Due to the limited availability of data in Italy, it is challenging to accurately assess the impact and implications of this phenomenon on the wild bee populations. In this study, a total of 3372 bees were sampled from 11 Italian regions within the BeeNet project, evaluating the prevalence and the abundance of the major honey bee pathogens (DWV, BQCV, ABPV, CBPV, KBV, Nosema ceranae, Ascosphaera apis, Crithidia mellificae, Lotmaria passim, Crithidia bombi). The 68.4% of samples were positive for at least one pathogen. DWV, BQCV, N. ceranae and CBPV showed the highest prevalence and abundance values, confirming them as the most prevalent pathogens spread in the environment. For these pathogens, Andrena, Bombus, Eucera and Seladonia showed the highest mean prevalence and abundance values. Generally, time trends showed a prevalence and abundance decrease from April to July. In order to predict the risk of infection among wild bees, statistical models were developed. A low influence of apiary density on pathogen occurrence was observed, while meteorological conditions and agricultural management showed a greater impact on pathogen persistence in the environment. Social and biological traits of wild bees also contributed to defining a higher risk of infection for bivoltine, communal, mining and oligolectic bees. Out of all the samples tested, 40.5% were co-infected with two or more pathogens. In some cases, individuals were simultaneously infected with up to five different pathogens. It is essential to increase knowledge about the transmission of pathogens among wild bees to understand dynamics, impact and effects on pollinator populations. Implementing concrete plans for the conservation of wild bee species is important to ensure the health of wild and human-managed bees within a One-Health perspective.

Muscle Strength of Lower Limbs as a Postoperative Predictor in Bariatric Surgery.

OBJECTIVE: The aim of our study was to assess postoperative lower limbs muscle strength (MS) as a predictor of late surgical success (36 months). METHODS: Body composition analyses and isokinetic dynamometry evaluation were performed before (T0: n=123), six months (T1: n=123) and 36 months (T2: n=79) after Roux-en-y gastric bypass (RYGB). Surgical success (SS) was defined as ≥ 50% excess weight loss (EWL) 36 months after surgery or ≤ 50% surgical failure (SF). RESULTS: There was no difference between relative MS extension (Ext) and flexion (Flex) in T1 and T2. There was also, no difference between relative MS Ext and Flex in T1 and T2 between patients with SS and SF. There was a difference in relative MS Ext (144.9 ± 39.8 Nm/kg x 125.5 ± 29.2 Nm/kg; p=0.04) and Flex (73.6 ± 21.8 Nm/kg x 60.4 ± 15.8 Nm/kg; p=0.02) between SS and SF patients only in T2. Patients with an increment in Ext and Flex MS ≥4 Nm/kg at T1 had approximately 76% of SS at 36 months. CONCLUSION: An increase of lower limbs MS ≥4 Nm/kg 6 months after RYGB predicts SS at 36 months. CLINICALTRIALS: gov ID: NCT04129801.

IMPACT OF HELICOBACTER PYLORI ON EARLY POSTOPERATIVE COMPLICATIONS AFTER SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eight retrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. The need for routine screening and treatment of HP infection before SG remains ambiguous.

VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY.

BACKGROUND: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.

Weight stigma after bariatric surgery: A qualitative study with Brazilian women.

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.

Roux-en-Y gastric bypass affects the expression of genes related to the intestinal folate metabolism pathway in obese women.

OBJECTIVES: Roux-en-Y gastric bypass (RYGB) promotes sustained weight loss, and the resulting new gastrointestinal anatomy can contribute to nutritional depletions. Folate deficiency is one of the most frequently observed nutritional deficiencies after RYGB. The aim of this study was to assess whether RYGB affects the expression of genes related to the intestinal folate metabolism pathway as an additional molecular mechanism contributing to its postoperative deficiency. METHODS: Biopsies from the duodenum, jejunum, and ileum of 20 obese women were collected before and 3 mo after RYGB. The expression of genes involved in intestinal folate metabolism was assessed by microarray and reverse transcriptase polymerase chain reaction (RT-qPCR). Folate intake (7-d food record) and plasma levels (electrochemiluminescence) also were measured. RESULTS: Compared with the preoperative phase, transcriptomic alterations were observed in all intestinal segments studied after RYBG, mainly marked by decreased expression of genes encoding folate transporters/receptors and increased expression of genes involved in folate biosynthesis (P < 0.05). Reduced folate intake and plasma folate levels were also observed simultaneously (P < 0.05). Plasma folate concentrations correlated inversely with intestinal FOLR2 and SHMT2 genes (P < 0.001). CONCLUSION: The present findings suggested that impaired expression of genes related to intestinal folate metabolism may contribute to the early systemic deficiency after RYGB and highlight a potential transcriptomic reprogramming of the intestine in response to RYGB to compensate for folate depletion induced by this surgical technique.

Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?

Background and study aims Significant weight regain affects up to one-third of patients after Roux-en-Y gastric bypass (RYGB) and demands treatment. Transoral outlet reduction (TORe) with argon plasma coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short term. However, no study has investigated the course of gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedure year. Patients and methods Patients eligible for a 36-month follow-up visit after TORe underwent upper gastrointestinal endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJ anastomosis (GJA) size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to pre-procedure levels. Only the energy/fatigue domain improvement was kept between the 1- and 3-year visits. Conclusions Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered iterative rather than a one-off procedure.

Exercise training and DNA methylation profile in post-bariatric women: Results from an exploratory study.

Exercise training and bariatric surgery have been shown to independently modulate DNA methylation profile in clusters of genes related to metabolic and inflammatory pathways. This study aimed to investigate the effects of a 6-month exercise training program on DNA methylation profile in women who underwent bariatric surgery. In this exploratory, quasi-experimental study, we analyzed DNA methylation levels by array technology in eleven women who underwent Roux-en-Y Gastric Bypass and a 6-month, three-times-a-week, supervised exercise training program. Epigenome Wide Association Analysis showed 722 CpG sites with different methylation level equal to or greater than 5% (P < 0.01) after exercise training. Some of these CpGs sites were related to pathophysiological mechanisms of inflammation, specially Th17 cell differentiation (FDR value < 0.05 and P < 0.001). Our data showed epigenetic modification in specific CpG sites related to Th17 cell differentiation pathway in post-bariatric women following a 6-months exercise training program.

Green Chemometric-Assisted Characterization of Common and Black Varieties of Celery.

Celery (Apium graveolens L., var. Dulce), is a biennial herbaceous plant belonging to the Apiaceae family, cultivated in humid soils in the Mediterranean basin, in Central-Southern Europe, and in Asia. Despite its wide diffusion and although it is well-known that cultivar/origin strongly influences plant composition, only a few studies have been carried out on the different types of celery. The present work aims to investigate four different Italian types of celery (two common, Elne and Magnum celery, and two black, Torricella Peligna Black and Trevi Black celery), and to test, whether the combination of FT-IR spectroscopy and chemometrics allows their ecotype discrimination. The peculiarity of this study lies in the fact that all the analyzed celeries were grown in the same experimental field under the same soil and climate conditions. Consequently, the differences captured by the FT-IR-based tool are mainly imputable to the different ecotypes. In order to achieve this goal, FT-IR profiles were handled by two diverse classifiers: sequential preprocessing through ORThogonalization (SPORT) and soft independent modeling by class analogy (SIMCA). Eventually, the highest classification rate (90%, on an external set of 100 samples) has been achieved by SPORT.

Postoperative Resting Metabolic Rate and Successful Weight Loss After Roux-en-Y Gastric Bypass.

OBJECTIVE: To analyze whether changes in RMR 6 months after RYGB could be a predictor of weight loss on late follow-up. METHODS: Prospective study of 45 individuals submitted to RYGB in a university tertiary care hospital. Body composition was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before (T0), 6 (T1), and 36 months (T2) after surgery. RESULTS: RMR/day was lower in T1 (1.552 ± 275 kcal/day) than in T0 (1734 ± 372 kcal/day; p < 0.001) with a return to similar values at T2 (1.795 ± 396 kcal/day; p < 0.001). In T0, there was no correlation between RMR/kg and body composition. In T1, there was a negative correlation between RMR and BW, BMI, and % FM, and a positive correlation with % FFM. The results in T2 were similar to T1. There was a significant increase in RMR/kg between T0, T1, and T2 (13.6 ± 2.2 kcal/kg, 16.9 ± 2.7 kcal/kg, and 19.9 ± 3.4 kcal/kg) in the total group and according to gender. Eighty percent of the patients who had increased RMR/kg ≥ 2 kcal at T1 achieved > 50% EWL in T2, particularly in women (odds ratio: 27.09, p < 0.037). CONCLUSIONS: The increase in RMR/kg after RYGB is a major factor related to a satisfactory % excess weight loss on late follow-up.

Exercise modifies hypothalamic connectivity and brain functional networks in women after bariatric surgery: a randomized clinical trial.

BACKGROUND: Obesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise training on brain functional networks. METHODS: Thirty women eligible for bariatric surgery were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 15, age = 41.0 ± 7.3 years) or RYGB plus Exercise Training (RYGB + ET: n = 15, age = 41.9 ± 7.2 years). Clinical, laboratory, and brain functional connectivity parameters were assessed at baseline, and 3 (POST3) and 9 months (POST9) after surgery. The 6-month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated 3 months post-surgery (for RYGB + ET). RESULTS: Exercise superimposed on bariatric surgery (RYGB + ET) increased connectivity between hypothalamus and sensorial regions (seed-to-voxel analyses of hypothalamic connectivity), and decreased default mode network (DMN) and posterior salience (pSAL) network connectivity (ROI-to-ROI analyses of brain networks connectivity) when compared to RYGB alone (all p-FDR < 0.05). Increases in basal ganglia (BG) network connectivity were only observed in the exercised training group (within-group analyses). CONCLUSION: Exercise training is an important component in the management of post-bariatric patients and may improve the hypothalamic connectivity and brain functional networks that are involved in controlling food intake. TRIAL REGISTRATION: Clinicaltrial.gov: NCT02441361.

Validity of the brazilian-portuguese version of moorehead-ardelt quality of life questionnaire ii among patients with severe obesity / Validade da versão em português-brasileiro do questionário moorehead-ardelt quality of life-ii em pacientes com obesidade grave

ABSTRACT BACKGROUND: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.

RESUMO RACIONAL: Pacientes com obesidade apresentam múltiplas condições psiquiátricas comórbidas e experienciam prejuízos na qualidade de vida relacionada à saúde. Ferramentas confiáveis e válidas que avaliam a qualidade de vida relacionada à saúde são essenciais para a prática clínica. OBJETIVOS: Este estudo teve como objetivo investigar a confiabilidade e validade do Moorehead-Ardelt Quality of Life-II de seis itens entre pacientes com obesidade grave. MÉTODOS: Foram avaliados 387 pacientes (idade média de 43 anos, 78,8% mulheres, índice de massa corporal (IMC) médio de 46,5 kg/m², na lista de espera de um centro cirurgia bariátrica. Assistentes de pesquisa treinados aplicaram simultaneamente o Moorehead-Ardelt Quality of Life-II, a Escala de Depressão de Montgomery-Åsberg e a Avaliação Global do Funcionamento para avaliar, respectivamente, a qualidade de vida relacionada à saúde, os sintomas depressivos comórbidos e o nível funcional do paciente. RESULTADOS: A consistência interna do Moorehead-Ardelt Quality of Life-II foi considerada aceitável. A pontuação total do Moorehead-Ardelt Quality of Life-II foi correlacionada com a gravidade dos sintomas depressivos e nível funcional. Quanto maior o IMC, menor a qualidade de vida relacionada à saúde. O Moorehead-Ardelt Quality of Life-II apresentou uma estrutura unidimensional. CONCLUSÕES: O questionário Moorehead-Ardelt Quality of Life-II unidimensional é confiável e válido na avaliação da qualidade de vida relacionada à saúde em pacientes brasileiros com obesidade grave. O questionário permite avaliar rapidamente a qualidade de vida relacionada à saúde dos pacientes em diferentes contextos, considerando depressão e nível funcional.

Impact of helicobacter pylori on early postoperative complications after sleeve gastrectomy: a systematic review and meta-analysis / Impacto do helicobacter pylori em complicações precoces após a gastrectomia vertical: uma revisão sistemática e meta-análise

ABSTRACT The impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eight retrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. The need for routine screening and treatment of HP infection before SG remains ambiguous.

RESUMO O impacto do Helicobacter pylori (HP) nos desfechos pós-operatórios da Gastrectomia Vertical (GV) ainda é controverso. Uma revisão sistemática e meta-análise foram realizadas para comparar a incidência de complicações pós-operatórias depois da GV entre pacientes HP-positivo e HP-negativo. Oito estudos comparativos retrospectivos foram incluídos, englobando 4.877 indivíduos. A prevalência de infecção por HPnos espécimes gástricos ressecados variou de 7,77 a 43,20%. Não houve diferença estatística significante entre os grupos para complicações gerais (OR 1,46; IC95% 0,95-2,23; p=0,08), sangramento (OR 1,35; IC95% 0,70-2,60; p=0,38), e fístula (OR 1,74; IC95% 0,80-3,81; p=0,17). A necessidade de rastreio e erradicação rotineira do HP antes da GV permanece ambígua.

BONE HEALTH ASSESSMENT OF ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY.

BACKGROUND: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.

Avaliação da saúde óssea de pacientes idosos submetidos a cirurgia bariátrica / Bone health assessment of elderly patients undergoing bariatric surgery

ABSTRACT Background: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. Objective: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. Methods: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. Results: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. Conclusion: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.

RESUMO Contexto: A cirurgia bariátrica promove mudanças na composição corporal, que incluem a perda de densidade mineral óssea (DMO). Faltam estudos que avaliem a evolução da saúde óssea de idosos que foram submetidos a cirurgia bariátrica, e sobre eventuais diferenças nessa evolução, quando comparadas as técnicas Bypass gástrico (BP) e gastrectomia vertical (GV). Objetivo: Avaliar a saúde óssea de pacientes idosos com obesidade submetidos a cirurgia bariátrica. Métodos: Trata-se de estudo prospectivo randomizado, realizado com indivíduos de ambos os sexos, ≥65 anos, submetidos a BP ou GV e que atendiam os critérios de inclusão. Idade, sexo e comorbidades (diabetes mellitus tipo 2, hipertensão arterial, dislipidemia e osteoartrose) foram coletados no momento da cirurgia bariátrica. Dados antropométricos (peso, índice de massa corporal, percentual de perda de peso, percentual de excesso de peso), exames laboratoriais relacionados a saúde óssea e densitometria óssea foram realizados antes e com 24 meses de pós-operatório. A evolução das variáveis estudadas foi feita comparando o pré e pós-operatório da casuística como um todo e dos grupos separadamente e entre si. Resultados: Um total de 36 pacientes (BP, n=18; GV, n=18) foram avaliados. As características basais da amostra, exceto pelo sexo e índice de massa corporal, que era maior no BP, foram homogêneas. Após 24 meses, o BP foi superior para perda de peso (%PP) e perda de excesso de peso (%PEP). Quanto à saúde óssea, observou-se uma diminuição significante da DMO na coluna, fêmur proximal total e colo do fêmur em ambos os grupos, com uma média de queda de 5,1%, 10,5% e 15,1%, respectivamente. Além disso, a queda da DMO observada foi de até 25% no fêmur total após 24 meses, seis pacientes passaram de DMO normal para osteopenia e um de osteopenia para osteoporose. Não houve diferença nos valores de paratormônio. Entretanto, houve associação entre o aumento do paratormônio e a redução da DMO na coluna, particularmente no grupo BP. Não foi observado associação entre %PP e %PEP com a redução da DMO. Conclusão: A cirurgia bariátrica se relacionou com a redução da DMO, porém sem diferença estatística entre as duas técnicas cirúrgicas.