Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy.

OBJECTIVE: The objective of this study was to examine the use and outcomes of perioperative anticoagulation (AC) in obese patients with a known history of venous thromboembolism event (VTE). METHOD: A retrospective review of a prospective database for patients with a VTE history undergoing bariatric and general surgery at a single center (1/2008-12/2017) was performed. Factors assessed included demographics, surgical details, and outcomes. RESULTS: Sixty-five patients underwent 76 procedures: 46 females (71%); mean age 51 years (range 26-73), mean weight 284 pounds (range 110-558), mean body mass index 45 (range 19-87). Comorbidities include hypertension (60%), gastroesophageal reflux disease (54%), osteoarthritis (49%), obstructive sleep apnea (45%), and diabetes (37%). Operations: 22 general surgeries (29%), 20 sleeve gastrectomies (26%), 12 revisions/conversions (16%), 12 Roux-en-Y gastric bypasses (16%), and 10 gastric bands (13%). Modalities: 67% laparoscopic, 28% robotic, and 5% open. Twenty-two patients (34%) had a pre-operative inferior vena cava filter placed with no complications. The mean length of stay was 4.4 days (range 1-31). Complications: seven 30-day readmissions (9%), one 30-day reoperation (1%), and two 90-day VTEs (3%). Thirty-day readmissions: four for inability to tolerate PO, two for small bowel obstruction, and one for symptomatic anastomotic ulcer. CONCLUSIONS: In our patients, post-operative AC could be started without an increased risk of bleeding in patients with a history of VTE undergoing bariatric surgery.

OBJETIVO: Examinar el uso y los resultados de la anticoagulación perioperatoria en pacientes bariátricos con antecedentes de tromboembolia venosa (TEV). MÉTODO: Revisión retrospectiva (base de datos prospectiva) de pacientes sometidos a cirugía general y bariátrica (1/2008-12/2017). Se evaluaron datos demográficos, detalles quirúrgicos y resultados. RESULTADOS: Sesenta y cinco pacientes se sometieron a 76 procedimientos: 46 mujeres (71%), edad media 51 años (rango: 26-73), peso medio 284 libras (rango: 110-558), índice de masa corporal medio 45 (rango: 19-87). Comorbilidad: hipertensión (60%), enfermedad por reflujo gastroesofágico (54%), osteoartritis (49%), apnea obstructiva del sueño (45%), diabetes (37%). Operaciones: 22 cirugía general (29%), 20 gastrectomías en manga (26%), 12 revisiones/conversiones (16%), 12 Y-de-Roux (16%), 10 bandas gástricas (13%). Modalidades: 67% laparoscópica, 28% robótica, 5% abierta. A 22 pacientes (34%) se les colocó un filtro de vena cava inferior preoperatorio sin complicaciones. La estancia media fue de 4.4 días (rango: 1-31). Complicaciones: 7 reingresos a los 30 días (9%), 1 reoperación a los 30 días (1%), 2 TEV a los 90 días (3%). Reingresos a los 30 días: 4 por incapacidad para tolerar la vía oral, 2 obstrucciones de intestino delgado y 1 úlcera anastomótica sintomática. CONCLUSIONES: En nuestros casos, la anticoagulación posoperatoria pudo iniciarse sin aumento del riesgo de sangrado en pacientes con antecedentes de TVE sometidos a cirugía bariátrica.

Decreased Hepatic and Serum Levels of IL-10 Concur with Increased Lobular Inflammation in Morbidly Obese Patients.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is associated with obesity and ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Accumulating evidence in animal models suggests that loss of interleukin-10 (IL-10) anti-inflammatory actions might contribute to lobular inflammation, considered one of the first steps toward NASH development. However, the role of IL-10 in lobular inflammation remains poorly explored in humans. We examined mRNA and protein levels of IL-10 in liver biopsies and serum samples from morbidly obese patients, investigating the relationship between IL-10 and lobular inflammation degree. Materials and Methods: We prospectively enrolled morbidly obese patients of both sexes, assessing the lobular inflammation grade by the Brunt scoring system to categorize participants into mild (n = 7), moderate (n = 19), or severe (n = 13) lobular inflammation groups. We quantified the hepatic mRNA expression of IL-10 by quantitative polymerase chain reaction and protein IL-10 levels in liver and serum samples by Luminex Assay. We estimated statistical differences by one-way analysis of variance (ANOVA) and Tukey's multiple comparison test. Results: The hepatic expression of IL-10 significantly diminished in patients with severe lobular inflammation compared with the moderate lobular inflammation group (p = 0.01). The hepatic IL-10 protein levels decreased in patients with moderate or severe lobular inflammation compared with the mild lobular inflammation group (p = 0.008 and p = 0.0008, respectively). In circulation, IL-10 also significantly decreased in subjects with moderate or severe lobular inflammation compared with the mild lobular inflammation group (p = 0.005 and p < 0.0001, respectively). Conclusions: In liver biopsies and serum samples of morbidly obese patients, the protein levels of IL-10 progressively decrease as lobular inflammation increases, supporting the hypothesis that lobular inflammation develops because of the loss of the IL-10-mediated anti-inflammatory counterbalance.

Resultados cardiometabólicos de largo plazo tras cirugía bariátrica: control de comorbilidades, pérdida y reganancia de peso a los 5 años de seguimiento / Long-term cardiometabolic results after bariatric surgery: Control of comorbidities, weight loss and regain at 5 years of follow-up

Introducción. La cirugía bariátrica y metabólica (CBM) es efectiva en lograr pérdida de peso a corto plazo. Sin embargo, existe evidencia limitada en desenlaces clínicos y metabólicos a largo plazo. Métodos. Estudio longitudinal retrospectivo con pacientes llevados a baipás gástrico en Y de Roux (BGYR) o gastrectomía en manga (MG) por laparoscopia en Bogotá, D.C., Colombia, entre 2013 y 2021. El cambio de peso, control de comorbilidades y resultados metabólicos se recopilaron al inicio del estudio, 3, 6 y 12 meses después de cirugía, y anualmente hasta el quinto año. Las tasas de control de comorbilidades se evaluaron mediante la prueba Kaplan-Meier. Se utilizó un modelo de riesgos proporcionales de Cox para evaluar el efecto de covariables en la reganancia de peso. Resultados. De 1092 pacientes con CBM (71,4 % MG y 28,6 % BGYR), 67 % eran mujeres, con mediana de edad 48 años e índice de masa corporal de 35,5 Kg/m2. Después de cinco años de seguimiento, la tasa de control en diabetes mellitus fue 65,5 %, en hipertensión 56,6 % y en dislipidemia 43,6 %. La tasa de reganancia de peso fue 28 %, sin diferencias entre MG vs BGYR (p=0,482). El tiempo promedio hasta peso nadir fue 14 meses. La edad al momento de CBM fue el mejor predictor independiente de reganancia (HR=1,02, IC95% 1,01-1,04), pero con efecto clínico modesto. Conclusión. La CBM es segura y muestra beneficios a largo plazo en la pérdida de peso y control de comorbilidades en población colombiana.

Introduction. Bariatric and metabolic surgery (BMS) has shown its efficacy in achieving short-term weight loss. However, there is limited evidence regarding long-term clinical and metabolic outcomes. Methods. Retrospective longitudinal study with patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) interventions in Bogotá, Colombia, between 2013 and 2021. Weight change, comorbidity control, and metabolic outcomes were collected at the onset, 3-, 6-, and 12-month post-surgery, and annually up to the fifth year. Comorbidity control rates were assessed using the Kaplan-Meier test. A Cox proportional hazards model was used to evaluate the effect of covariates on weight regain. Results. Of 1092 patients with BMS (71.4% SG and 28.6% RYGB), 67% were women, with a median age of 48 years, BMI 35.5 kg/m2. After five years of follow-up, the control rate in diabetes mellitus was 65.5%, in hypertension 56.6%, and dyslipidemia 43.6%. The weight regain rate was 28% with no differences between SG vs RYGB (p=0.482). The mean time to nadir weight was 14 months. Age at the time of BMS was the best independent predictor of weight regain (HR=1.02, 95%CI: 1.01-1.04), but with a modest clinical effect. Conclusion. BMS is safe and shows long-term benefits in weight loss and control of comorbidities in Colombian population.

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.

Genetic association of the BsmI variant of vitamin D receptor gene with risk of morbid obesity

SUMMARY OBJECTIVE: The aim of this study was to evaluate the vitamin D receptor (VDR) BsmI variant in morbidly obese patients compared with healthy normal controls. METHODS: The study included 103 patients with morbid obesity and 120 healthy individuals serving as normal controls. The DNA samples obtained from blood were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The gender, age, smoking status, triglycerides, total cholesterol, insulin, mean body mass index, and frequency of allele and genotype of the BsmI variant in the VDR gene in morbidly obese patients were evaluated. RESULTS: The body mass index of the patients was 47.14 ± 7.19. The VDR B/B, B/b, and b/b genotype frequencies were 27.2% versus 28.3%; 54.4% versus 50%; and 18.4% versus 21.7% in the morbidly obese patients and the control group, respectively. There was no statistically significant difference between patients and control subjects in the genotype and allele distribution of the VDR BsmI variant (p>0.05). Both patients and control genotype frequencies are consistent with Hardy-Weinberg equilibrium. CONCLUSION: The BsmI variant in the VDR gene may not seem to predispose to morbid obesity in our study population. Further studies with a larger number of subjects are needed to make a more precise evaluation of this relationship.

Cirugía bariátrica: resultados clínicos en términos de pérdida de peso y resolución de comorbilidades / Bariatric surgery: Clinical outcomes in terms of weight loss and resolution of comorbidities

Introducción. La cirugía bariátrica es una estrategia válida de tratamiento en obesidad severa. El objetivo de este estudio fue evaluar la reducción de peso y la resolución de comorbilidades comparando dos técnicas quirúrgicas, baipás gástrico en Y de Roux y manga gástrica. Métodos. Estudio descriptivo de tipo analítico que incluyó pacientes con obesidad grados II y III. Se analizaron variables demográficas y perioperatorias, y las comorbilidades asociadas a la obesidad. La reducción del peso se evaluó con el porcentaje de pérdida del exceso de peso. Se realizó un análisis descriptivo univariado, usando medianas, rangos intercuartílicos, frecuencias y proporciones. Se usaron las pruebas de U de Mann-Whitney y Chi cuadrado para el análisis de grupos. Un valor de p<0,05 fue considerado estadísticamente significativo. Resultados. Fueron incluidos 201 pacientes. La mediana del porcentaje de pérdida del exceso de peso a 18 meses fue de 77,4 % para el grupo de baipás gástrico en Y de Roux vs 69,5 % para el grupo de manga gástrica (p=0,14). La mayoría de los pacientes presentaron resolución o mejoría de la hipertensión arterial (76 %), diabetes mellitus (80 %), dislipidemia (73 %), apnea del sueño (79 %) y artropatías (94 %), sin diferencia significativa según la técnica quirúrgica empleada. La tasa de complicaciones mayores fue del 1,9 %. No se presentó mortalidad. La mediana de seguimiento fue 28 meses. Conclusión. El baipás gástrico en Y de Roux y la manga gástrica son procedimientos muy seguros y efectivos para la reducción del exceso de peso y la resolución de las comorbilidades asociadas a la obesidad

Introduction. Bariatric surgery is a valid strategy of treatment for severe obesity. The aim of this study is to evaluate weight loss and resolution of comorbidities comparing two procedures, Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Descriptive study of analytical type that included patients with obesity grades II and III. Demographic and perioperative variables were analyzed. The weight reduction was evaluated among others with the percentage of excess of body weight loss. Comorbidities associated with obesity were also analyzed. A univariate descriptive analysis was performed, using medians, interquartile ranges, frequencies, and proportions. The Mann-Whitney U and Chi squared tests were used for analysis of groups. A value of p <0.05 was considered statistically significant. Median follow-up was 28 months. Results. A total of 201 patients were included in the analysis. The median percentage of excess of body weight loss at 18 months was 77.4% for Roux-en-Y gastric bypass group vs 69.5% for sleeve gastrectomy group (p=0.14). The majority of patients presented resolution or improvement of hypertension (76%), diabetes mellitus (80%), dyslipidemia (73%), sleep apnea (79%), and arthropathy (94%), without significant differences according to the surgical technique used. Major complication rate was 1.9%. There was not mortality. The median follow-up was 28 months. Conclusion. Roux-en-Y gastric bypass and sleeve gastrectomy are both very safe and effective procedures for excess weight reduction and resolution of comorbidities associated with obesity

Successful use of rivaroxaban achieving therapeutic anti-factor xa levels in a morbidly obese patient with acute intermediate-high risk pulmonary embolism.

Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m2 may be effective, and safe.

Devido à sua eficácia e aos seus perfis de segurança, os anticoagulantes orais diretos (DOACs) tornaram-se o padrão de cuidado para a terapia aguda e de longo prazo de tromboembolismo venoso (TEV). As diretrizes da Sociedade Internacional de Trombose e Hemostasia de 2021 recomendam o uso de dosagens padrão de DOACs em pacientes com índice de massa corporal (IMC) > 40 kg/m2 ou peso > 120 kg. O uso de DOACs em pacientes com obesidade mórbida e TEV, incluindo embolia pulmonar aguda, ainda não foi esclarecido. Uma mulher com obesidade mórbida na faixa dos 30 anos que apresentou piora aguda da dispneia foi diagnosticada com embolia pulmonar aguda de risco intermediário-alto e trombose venosa profunda proximal concomitante, com o cenário clínico desafiador de tratá-la com rivaroxabana. Doses padrão de rivaroxabana para tratamento e recorrência de tromboembolismo venoso em indivíduos com obesidade mórbida e IMC > 70 kg/m2 podem ser eficazes e seguras.

Bypass gastroplasty impacts oral health, salivary inflammatory biomarkers, and microbiota: a controlled study.

OBJECTIVES: Knowledge about the impact of gastroplasty on oral health and salivary biomarkers is limited. The aim was to prospectively evaluate oral health status, salivary inflammatory markers, and microbiota in patients undergoing gastroplasty compared with a control group undergoing a dietary program. MATERIALS AND METHODS: Forty participants with obesity class II/III were included (20 individuals in each sex-matched group; 23-44 years). Dental status, salivary flow, buffering capacity, inflammatory cytokines, and uric acid were assessed. Salivary microbiological analysis (16S-rRNA sequencing) assessed the abundance of genus, species, and alpha diversity. Cluster analysis and mixed-model ANOVA were applied. RESULTS: Oral health status, waist-to-hip ratio, and salivary alpha diversity were associated at baseline. A subtle improvement in food consumption markers was observed, although caries activity increased in both groups, and the gastroplasty group showed worse periodontal status after three months. IFNγ and IL10 levels decreased in the gastroplasty group at 3 months, while a decrease was observed in the control group at 6 months; IL6 decreased in both groups (p < 0.001). Salivary flow and buffering capacity did not change. Significant changes in Prevotella nigrescens and Porphyromonas endodontalis abundance were observed in both groups, while alpha diversity (Sobs, Chao1, Ace, Shannon, and Simpson) increased in the gastroplasty group. CONCLUSIONS: Both interventions changed in different degrees the salivary inflammatory biomarkers and microbiota, but did not improve the periodontal status after 6 months. CLINICAL RELEVANCE: Although the observed discrete improvement in dietary habits, caries activity increased with no clinical improvement in the periodontal status, emphasizing the need of oral health monitoring during obesity treatment.

Laparoscopic sleeve gastrectomy versus laparoscopic roux-en-y gastric bypass for weight loss in obese patients: which is more effective? a systematic review and meta-analysis / Gastrectomia vertical laparoscópica versus by-pass gástrico na perda de peso em pacientes obesos: qual é mais efetiva? uma revisão sistemática

ABSTRACT BACKGROUND: Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS: To determine if LSG is more effective than RYLGB for weight loss. METHODS: A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS: Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS: The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.

RESUMO RACIONAL: A cirurgia bariátrica é a opção mais eficaz para reduzir o peso em pacientes com obesidade mórbida. Três técnicas são mais empregadas: gastrectomia vertical laparoscópica (LSG), procedimentos cirúrgicos de má absorção intestinal e ambos os tipos, má absorção intestinal e restritiva, e bypass laparoscópico em Y-Roux (RYLGB). OBJETIVOS: Determinar a eficácia da LSG versus RYLGB na perda de peso. MÉTODOS: Uma revisão sistemática e meta-análise foi realizada incluindo cinco ensaios clínicos e dezesseis coortes comparando LSG versus RYLGB na perda de peso e resultados secundários, resolução de comorbidades, complicações pós-operatórias, tempo operatório, permanência hospitalar e melhora da qualidade de vida. RESULTADOS: A perda de excesso de peso foi 10,2% (diferença média (MD) 10,2; IC95% -10,14; -9,90) maior em pacientes submetidos a LSG do que em pacientes operados com RYLGB. Diabetes mellitus tipo 2 foi resolvido em 17% (risco relativo (RR) 0,83; IC95% 0,77-0,90), hipertensão arterial em 23% (RR 0,77; IC95% 0,69-0,84), dislipidemia em 17% (RR 0,83; IC95% 0,77-0,90), mais significativos após LSG. As complicações pós-operatórias foram 73% maiores em pacientes submetidos a RYLGB (MD 0,73; IC95% 0,63-0,83). O tempo operatório foi 35,76 minutos menor na LSG (MD -35,76; IC95% -37,28; -34,24). Finalmente, a qualidade de vida melhorou mais no LSG (MD 0,37; IC95% -0,48; -0,26). CONCLUSÕES: LSG é muito eficaz na redução do excesso de peso, comorbidades, complicações pós-operatórias, tempo e melhora na qualidade de vida.

Experiencia en bypass gástrico reseccional laparoscópico en pacientes con obesidad mórbida. Primer estudio en Venezuela / Experience in laparoscopic resectional gastric bypass in patients with morbid obesity. First study in Venezuela

El Bypass Gástrico Reseccional, consiste en realizar gastrectomía casi total más anastomosis gastro-yeyunal, con las desventajas de no ser reversible, y disminuir la absorción de los elementos que requieren ácidos gástricos. Objetivo: Describir la experiencia en Bypass Gástrico Reseccional Laparoscópico en pacientes con Obesidad Mórbida, intervenidos en el Centro Quirúrgico Carabobo 200 y en el Instituto Docente de Urología, Carabobo ­ Venezuela, durante el periodo comprendido entre enero ­ diciembre 2.021. Materiales: Investigación descriptiva, retrospectiva, longitudinal y multicéntrica, no probabilístico, comprendiendo 3 pacientes. Se utilizó una ficha de recolección de datos confeccionada para tal fin que incluyó datos clínicos y de laboratorio, previos y posterior a la cirugía, siendo evaluados a los 3, 6 y 12 meses respectivamente. Resultados: Causa más frecuente: presencia de lesiones gástricas benignas en 66.66% de los casos, y falla de técnica bariátrica primaria en 33.33%. Todos los pacientes del estudio presentaban comorbilidades cardiovasculares y metabólicas, siendo las más relevantes; Hipertensión Arterial Sistémica 100%, resistencia a insulina 66.66%, apnea del sueño 66.66% y Diabetes Mellitus tipo 2, en 33.33%. Conclusiones: El Bypass Gástrico Reseccional Laparoscópico tiene buenos resultados en pacientes obesos, con riesgo a desarrollar cáncer gástrico y en fallo de técnica primaria. No hubo complicación transoperatoria. La pérdida de exceso de peso fue exitosa (promedio 85.78% al año). Solo 1 caso presentó complicación postoperatoria tardía de anemia leve con diagnóstico y resolución oportuna. No se evidenciaron otras complicaciones(AU)

The Resectional Gastric Bypass consists of performing almost total gastrectomy plus gastro-jejunal anastomosis, with the disadvantages of not being reversible, and decreasing the absorption of elements that require gastric acids. Objective: To describe the experience in Laparoscopic Resectional Gastric Bypass in patients with Morbid Obesity, operated on at the Carabobo 200 Surgical Center and at the Teaching Institute of Urology, Carabobo - Venezuela, during the period between January - December 2021. Materials: Descriptive, retrospective, longitudinal, and multicenter, non-probabilistic research, involving 3 patients. A data collection sheet prepared for this purpose was drawn up, which included clinical and laboratory data, before and after surgery, being evaluated at 3, 6 and 12 months respectively. Results: Most frequent cause: presence of benign gastric lesions in 66.66% of cases, and primary bariatric technique failure in 33.33%. All the patients in the study presented cardiovascular and metabolic comorbidities, being the most relevant; Systemic Arterial Hypertension 100%, insulin resistance 66.66%, sleep apnea 66.66% and Diabetes Mellitus type 2, in 33.33%. Conclusions: Laparoscopic Resectional Gastric Bypass has good results in obese patients, at risk of developing gastric cancer and in primary technique failure. There were no intraoperative complications. Excess weight loss was successful (average 85.78% per year). Only 1 case presented late postoperative complication of mild anemia with timely diagnosis and resolution. No other complications were found(AU)

Existe associação entre temperamento afetivo e obesidade mórbida em candidatos à cirurgia bariátrica? / Is there an association between affective temperament and morbid obesity in candidates for bariatric surgery?

Introdução: Inúmeros estudos têm demonstrado forte relação entre obesidade e doenças psiquiátricas, especialmente doenças do humor. Contudo, poucos avaliaram a correlação entre obesidade mórbida e temperamento afetivo. Objetivo: Estudar a existência de temperamento afetivo em obesos mórbidos antes do tratamento cirúrgico da obesidade. Métodos: O material para leitura e análise foi selecionado a partir de pesquisa em plataformas virtuais com foco nos temperamentos afetivos (hipertimia, distimia e ciclotimia). Inicialmente foi realizada busca por descritores relacionados ao tema (temperamento, obesidade mórbida, cirurgia bariátrica, transtornos do humor" e seus equivalentes em inglês com busca AND ou OR), considerando o título e/ou resumo, e a seguir a leitura do trabalho na íntegra. Resultados: As comorbidades psiquiátricas mais frequentes no sobrepeso e obesidade foram os transtornos do humor, de ansiedade e da compulsão alimentar. A prevalência estimada de temperamentos afetivos em obesos mórbidos é cerca de 65% Conclusão: A prevalência de temperamentos afetivos é maior em obesos mórbidos, candidatos a cirurgia bariátrica, em comparação a população geral. O temperamento ciclotímico é o mais comum na população de pacientes com obesidade mórbida.

Introduction: Numerous studies have demonstrated a strong relationship between obesity and psychiatric diseases, especially mood disorders. However, few have evaluated the correlation between morbid obesity and affective temperament. Objective: To study the existence of affective temperament in morbidly obese individuals before surgical treatment of obesity. Methods: The material for reading and analysis was selected from research on virtual platforms focusing on affective temperaments (hyperthymia, dysthymia and cyclothymia). A search was carried out for descriptors related to the topic ("temperament, morbid obesity, bariatric surgery, mood disorders" and their equivalents in English with AND or OR search), considering the title and/or abstract, and then reading the work in full. Results: The most common psychiatric comorbidities in overweight and obesity were mood, anxiety and binge eating disorders. The estimated prevalence of affective temperaments in morbidly obese people is about 65%. Conclusion: The prevalence of affective temperaments is higher in morbidly obese people, candidates for bariatric surgery, compared to the general population. Cyclothymic temperament is the most common in the morbidly obese patient population.

Successful use of rivaroxaban achieving therapeutic anti-factor xa levels in a morbidly obese patient with acute intermediate-high risk pulmonary embolism / Uso bem-sucedido de rivaroxabana com níveis terapêuticos de antifator xa em paciente com obesidade mórbida e embolia pulmonar aguda de risco intermediário-alto

Abstract Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m2 may be effective, and safe.

Resumo Devido à sua eficácia e aos seus perfis de segurança, os anticoagulantes orais diretos (DOACs) tornaram-se o padrão de cuidado para a terapia aguda e de longo prazo de tromboembolismo venoso (TEV). As diretrizes da Sociedade Internacional de Trombose e Hemostasia de 2021 recomendam o uso de dosagens padrão de DOACs em pacientes com índice de massa corporal (IMC) > 40 kg/m2 ou peso > 120 kg. O uso de DOACs em pacientes com obesidade mórbida e TEV, incluindo embolia pulmonar aguda, ainda não foi esclarecido. Uma mulher com obesidade mórbida na faixa dos 30 anos que apresentou piora aguda da dispneia foi diagnosticada com embolia pulmonar aguda de risco intermediário-alto e trombose venosa profunda proximal concomitante, com o cenário clínico desafiador de tratá-la com rivaroxabana. Doses padrão de rivaroxabana para tratamento e recorrência de tromboembolismo venoso em indivíduos com obesidade mórbida e IMC > 70 kg/m2 podem ser eficazes e seguras.

Factores de riesgo asociados a la pérdida insuficiente o ganancia significativa de peso en pacientes sometidos a cirugía bariátrica / Risk factors associated with insufficient weight loss or significant weight gain in patients undergone bariatric surgery

Introducción. La cirugía bariátrica es efectiva para inducir una rápida pérdida del exceso de peso, pero existen dudas sobre la duración de este efecto a largo plazo. Este estudio buscaba identificar la proporción de pacientes operados que presentaron una pérdida insuficiente o una ganancia significativa de peso y los posibles factores relacionados. Métodos. Estudio de cohorte retrospectivo en pacientes adultos sometidos a cirugía bariátrica. Se describieron variables demográficas y clínicas. Se realizó un análisis multivariado para identificar factores relacionados con un peso fuera de metas posterior a la cirugía. Resultados. Se incluyeron 187 pacientes, 117 con baipás gástrico y 70 con manga gástrica. La mediana de índice de masa corporal preoperatorio fue 41,3 kg/m2 y postoperatorio de 28,8 kg/m2. El 94,7 % de los pacientes en ambos grupos logró una adecuada pérdida del exceso de peso. La ganancia de peso mayor del 20 % se presentó en el 43,5 % de los pacientes, siendo mayor en el grupo de manga gástrica (p<0,004). Los factores independientes para ganancia de peso fueron el sexo masculino (OR 5,5), cirugía tipo manga gástrica (OR 3,4), síndrome de apnea del sueño (OR 2,9) y enfermedad mental medicada (OR 2,8). Conclusión. La cirugía bariátrica produce una pérdida del exceso de peso suficiente en casi la totalidad de los pacientes, pero un buen número recuperan peso luego de 3 años. Los principales factores asociados a ganancia de peso son el sexo masculino y la cirugía tipo manga gástrica

Introduction. Bariatric surgery is highly effective in inducing rapid excess body weight loss but there are doubts about its effect on long-term. This study seeks to identify the number of patients that underwent bariatric surgery who present insufficient weight loss or significant weight gain and the possible related factors. Methods. Retrospective cohort study of adult patients who underwent bariatric surgery. Demographic and clinical variables are described. A multivariate analysis was performed to identify factors related to patient weight outside the set goals postoperatively. Results. 187 patients were included (117 gastric bypass, 70 gastric sleeve). The median preoperative body mass index was 41m/kg2 and 28.8m/kg2 postoperatively. 94.7% of the patients in both groups achieved adequate excess body weight loss. Weight gain (>20%) occurred in 43.5% of the patients, with the probability being higher in the gastric sleeve group (p<0.004). Independent factors for weight gain were male gender (OR 5.5), gastric sleeve surgery (OR 3.4), sleep apnea syndrome (OR 2.9), and mental illness under treatment (OR 2.8). Conclusions. Bariatric surgery produces sufficient loss of excess weight in almost all patients, but a good number of them regain weight after 3 years. The main factors associated with weight gain are male gender and gastric sleeve surgery

Cirugía laparoscópica en pacientes con obesidad mórbida y cáncer de endometrio

Introducción: La cirugía, en pacientes con obesidad mórbida, como tratamiento del cáncer ginecológico supone un reto para el cirujano y el anestesiólogo, pues se asocia a un incremento de las complicaciones intra y posoperatorias. Objetivo: Describir los principales resultados con la cirugía laparoscópica, en pacientes con obesidad mórbida y adenocarcinoma de endometrio, tratadas en el Instituto Nacional de Oncología y Radiobiología (INOR) de la Habana, Cuba, en el período comprendido enero de 2019 a marzo de 2020. Método: Se realizó un estudio descriptivo, observacional y transversal, en 22 pacientes con índice de masa corporal mayor de 40 kg/m2 y diagnóstico de adenocarcinoma de endometrio, que fueron sometidas a cirugía laparoscópica. El dato primario fue obtenido a través de las historias clínicas, con los que se confeccionó una base de datos en una hoja de Microsoft Excel para sintetizar toda la información. Resultados: Predominó la edad entre 61 a 70 años. El adenocarcinoma endometrioide fue el más frecuente con el 77,27 %. El grado de diferenciación fue el bien diferenciado, infiltrando menos del 50 % del miometrio. El estadiamiento quirúrgico predominante fue el IA (72,72 %). El sangrado transoperatorio fue de 78,9 ± 5,7ml (rango 10 y 200 ml), la media del acto operatorio de 82 min (rango 75-132 min), y la estadía hospitalaria de menos de 24 horas (90,90 %). La conversión quirúrgica se realizó en el 4,54 % de los casos. Conclusiones: Las pacientes con obesidad mórbida pueden beneficiarse del abordaje laparoscópico para el tratamiento y la estatificación quirúrgica laparoscópica del carcinoma endometrial, lo que disminuye la morbilidad y la estadía hospitalaria.

Introduction: Surgery in morbidly obese patients as a treatment for gynecologic cancer is a challenge for surgeons and anesthesiologists, since it is associated with the processes of increasing intraoperative and postoperative complications. Objective: To describe the main results gained with the use of laparoscopic surgery in patients with morbid obesity and endometrial adenocarcinoma treated at the Instituto Nacional de Oncología y Radiobiología (INOR) of Havana, Cuba, from January 2019 to March 2020. Method: A descriptive, observational, cross-sectional study was carried out in 22 patients, with body mass index more than 40 kg/m2 and diagnosis of endometrial adenocarcinoma, who underwent laparoscopic surgery. The primary data was obtained from the medical records, which were used to create a database in a Microsoft Excel spreadsheet to synthesize all the information. Results: The predominant age group was between 61 and 70 years old. Endometrial adenocarcinoma was the most frequent cancer (77.27%). The degree of differentiation was well differentiated, infiltrating less than 50 % of the myometrium. The predominant surgical staging was IA (72.72%). Transoperative bleeding was 78.9 ± 5.7 ml (range between 10 and 200 ml), mean operative time was 82 min (range 75-132 min), and hospital stay was less than 24 hours (90.90%). Surgical conversion was performed in 4.54% of cases. Conclusions: Morbidly obese patients may benefit from the laparoscopic approach for the treatment and laparoscopic surgical staging of endometrial carcinoma, which decreases morbidity and hospital stay.

Introdução: A cirurgia, em pacientes com obesidade mórbida, como tratamento para o câncer ginecológico é um desafio para o cirurgião e para o anestesiologista, pois está associada ao aumento de complicações intra e pós-operatórias. Objetivo: Descrever os principais resultados da cirurgia laparoscópica, em pacientes com obesidade mórbida e adenocarcinoma endometrial, tratados no Instituto Nacional de Oncología y Radiobiología (INOR) em Havana, Cuba, no período de janeiro de 2019 a março de 2020. Método: A estudo descritivo, observacional e transversal realizado em 22 pacientes com índice de massa corporal superior a 40 kg/m2 e diagnóstico de adenocarcinoma de endométrio, submetidas à cirurgia laparoscópica. Os dados primários foram obtidos por meio dos prontuários, com os quais foi criado um banco de dados em uma planilha do Microsoft Excel para sintetizar todas as informações. Resultados: Predominou a idade entre 61 a 70 anos. O adenocarcinoma endometrioide foi o mais frequente com 77,27%. O grau de diferenciação foi bem diferenciado, infiltrando menos de 50% do miométrio. O estadiamento cirúrgico predominante foi IA (72,72%). O sangramento transoperatório foi de 78,9 ± 5,7 ml (variação de 10 e 200 ml), a média do ato cirúrgico foi de 82 min (variação de 75-132 min) e o tempo de internação foi inferior a 24 horas (90,90%). A conversão cirúrgica foi realizada em 4,54% dos casos. Conclusões: Pacientes com obesidade mórbida podem se beneficiar da abordagem laparoscópica para o tratamento e estadiamento cirúrgico laparoscópico do carcinoma endometrial, o que diminui a morbidade e o tempo de internação.

Exercise Training Program Improves Subjective Sleep Quality and Physical Fitness in Severely Obese Bad Sleepers.

BACKGROUND: Sleep quality is an important modulator of neuroendocrine function, as sleep problems are related to metabolic and endocrine alterations. OBJECTIVE: The main objective was to determine the effects of an exercise training program on the sleep quality of severely obese patients with sleep problems. The secondary objective was to determine the relationship between fitness and anthropometric parameters with sleep quality scores. METHODS: Thirty severely obese patients participated in 16 weeks of PA intervention (age: 39.30 ± 11.62 y, BMI: 42.75 ± 5.27 kg/m2). Subjective sleep quality, anthropometric parameters, and fitness (i.e., handgrip strength and cardiorespiratory fitness) were measured. RESULTS: Two groups were defined as good sleepers (n = 15, 38.06 ± 12.26, men = 1) and bad sleepers (n = 15, 40.53 ± 11.23, men = 3). The good sleeper group reported improvement in cardiorespiratory fitness (61.33 ± 68.75 m vs. 635.33 ± 98.91 m, p = 0.003) and handgrip strength (29.63 ± 9.29 kg vs. 31.86 ± 7.17 kg, p = 0.049). The bad sleeper group improved their cardiorespiratory fitness (472.66 ± 99.7 m vs. 611.33 ± 148.75 m, p = 0.001). In terms of sleep quality dimensions, the bad sleeper group improved their subjective sleep quality (p < 0.001), sleep latency (p = 0.045), sleep duration (p = 0.031), and habitual sleep efficiency (p = 0.015). Comparing the changes in both groups (∆), there were differences in subjective sleep quality scores (∆ = 2.23 vs. ∆ = -3.90, p = 0.002), where 86.6% of the bad sleeper group improved sleep quality (p = 0.030). An increase in handgrip strength was correlated to improving sleep quality scores (r = -0.49, p = 0.050). CONCLUSIONS: Severely obese bad sleepers improved their subjective sleep quality, the components of sleep, and cardiorespiratory fitness through an exercise training program. Improvement in subjective sleep quality was linked to an increase in handgrip strength.

Characterizing the interindividual postexercise hypotension response for two order groups of concurrent training in patients with morbid obesity.

Background: Postexercise hypotension (PEH) is a common physiological phenomenon occurring immediately after endurance training (ET), resistance training (RT), and ET plus RT, also termed concurrent training (CT); however, there is little knowledge about the interindividual and magnitude response of PEH in morbidly obese patients. Aim: The aims of this study were (1) to investigate the effect of CT order (ET + RT vs. RT + ET) on the blood pressure responses; 2) characterize these responses in responders and nonresponders, and 3) identify potential baseline outcomes for predicting blood pressure decreases as responders. Methods: A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6 ± 11.3 years; body mass index [BMI] ≥40 kg/m2) was assigned to a CT group of ET plus RT (ET + RT; n = 19; BMI 47.8 ± 16.7) or RT plus ET order group (RT + ET; n = 17; BMI 43.0 ± 8.0). Subjects of both groups received eight exercise sessions over four weeks. Primary outcomes include systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 min post-exercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical fitness parameters. Using the delta ∆SBP reduction, quartile categorization (Q) in "high" (Rs: quartile 4), "moderate" (MRs: quartile 3), "low" (LRs: quartile 2), and "nonresponders" (NRs: quartile 1) was reported. Results: Significant pre-post changes were observed in ET + RT in session 2 for SBP (131.6 vs. 123.4 mmHg, p = 0.050) and session 4 (131.1 vs. 125.2 mmHg, p = 0.0002), while the RT + ET group showed significant reductions in session 4 (134.2 vs. 125.3 mmHg, p < 0.001). No significant differences were detected in the sum of the eight sessions for SBP (∑∆SBP) between ET + RT vs. RT + ET (-5.7 vs. -4.3 mmHg, p = 0.552). Interindividual analyses revealed significant differences among frequencies comparing Q1 "NRs" (n = 8; 22.2%), Q2 "LRs" (n = 8; 22.2%), Q3 "MRs" (n = 9; 25.0%), and Q4 "HRs" (n = 11; 30.5%), p < 0.0001. Quartile comparisons showed significant differences in SBP changes (p = 0.035). Linear regression analyses revealed significant association between ∑∆SBP with body fat % (ß -3.826, R 2 0.211 [21.1%], p = 0.031), skeletal muscle mass [ß -2.150, R 2 0.125 (12.5%), p = 0.023], fasting glucose [ß 1.273, R 2 0.078 (7.8%), p = 0.003], triglycerides [ß 0.210, R 2 0.014 (1.4%), p = 0.008], and the 6-min walking test [ß 0.183, R 2 0.038 (3.8%), p = 0.044]. Conclusion: The CT order of ET + RT and RT + ET promote a similar 'magnitude' in the postexercise hypotensive effects during the eight sessions of both CT orders in 4 weeks of training duration, revealing "nonresponders" and 'high' responders that can be predicted from body composition, metabolic, and physical fitness outcomes.

The Social Distance Impacts from COVID-19 Pandemic on the Development of Two Orders of a Concurrent Training Programme for Morbidly Obese Patients.

BACKGROUND: Although there is relevant information regarding the consequences of the coronavirus SARS-CoV-2 (COVID-19), little is known about the impact of the imposed social confinement (at home) on the development of exercise training programmes in populations with morbid obesity. AIM: To describe the effects of the imposed COVID-19 confinement on the cardiometabolic health benefits acquired through a concurrent training programme that started before the pandemic in populations with morbid obesity. METHODS: This was an experimental randomized clinical study, in which sedentary morbidly obese women were assigned 1:1 to a high-intensity interval training (HIIT) plus resistance training (RT) group (HIIT + RT; n = 11; BMI 42.1 ± 6.6) or to the same exercise dose, but in different order group of RT plus HIIT group (RT + HIIT; n = 7; BMI 47.5 ± 8.4). Both groups undertook two sessions/week. When COVID-19 confinement at home started, a post-test was applied in January 2020 (Post1) and after 20 months (Post2). The main outcomes were waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), high-density lipids (HDL-c), triglycerides (Tg), and fasting plasma glucose (FPG). RESULTS: In the HIIT + RT group, the WC showed significant increases from Post1 to Post2 (Δ + 3.1 cm, p = 0.035); in the RT + HIIT group, it decreased from Post1 to Post2 (Δ - 4.8 cm, p = 0.028). In the HIIT + RT group, SBP showed significant increases from Post1 to Post2 (Δ + 6.2 mmHg, p = 0.041); the RT + HIIT group decreased SBP from Pre0 to Post1 (Δ - 7.2 mmHg, p = 0.026) and increased DBP from Pre0 to Post1 (Δ + 8.1 mmHg, p = 0.015). Tg in the HIIT + RT group decreased from Pre0 to Post1 (Δ - 40.1 mg/dL, p = 0.023) but increased from Post1 to Post2 (Δ + 86.3 mg/dL, p < 0.0001). CONCLUSIONS: The COVID-19 social confinement worsened metabolic syndrome (MetS) outcomes that had improved from 20 weeks' RT + HIIT during the training period, such as WC, SBP, and Tg from HIIT + RT, when, worryingly, SBP increased to another more serious clinical classification in both groups.

Concurrent training and interindividual response in women with a high number of metabolic syndrome risk factors.

The non-responders (NRs) after exercise training have been poorly studied in populations with morbid obesity. The purpose of this study was to determine the NR prevalence after 20 weeks of concurrent training of morbidly obese women with a high or low number of metabolic syndrome (MetS) risk factors. Twenty-eight women with morbid obesity participated in an exercise training intervention and were allocated into two groups distributed based on a high (≥3, n = 11) or low number (<3, n = 17) of MetS risk factors. The main outcomes were waist circumference (WC), fasting plasma glucose (FPG), high-density lipids (HDL-c), triglycerides (Tg), and systolic (SBP) and diastolic (DBP) blood pressure, and secondary outcomes were body composition, anthropometric and physical fitness, determined before and after 20 weeks of concurrent training. NRs were defined as previously used technical error cut-off points for the MetS outcomes. Significantly different (all p < 0.05) prevalences of NRs between the H-MetS vs. L-MetS groups (respectively) in WC (NRs 18.2 % vs. 41.1 %, p < 0.0001), SBP (NRs 72.7 % vs. 47.0 %, p = 0.022), DBP (NRs 54.5 % vs. 76.4 %, p < 0.0001), FPG (NRs 100% vs. 64.8 %, p < 0.0001), and HDL-c (NRs 90.9 % vs. 64.7 %, p = 0.012) were observed. In addition, the H-MetS group evidenced significant changes on ΔSBP (-10.2 ± 11.4 mmHg), ΔFPG (-5.8 ± 8.2 mg/dl), ΔHDL-c (+4.0 ± 5.9 mg/dl), and ΔTg (-8.8 ± 33.8 mg/dl), all p < 0.05. The L-MetS group only showed significant changes in ΔWC (-3.8 ± 5.0 cm, p = 0.009). Comparing H-MetS vs. L-MetS groups, significant differences were observed in ∆FPG (-5.8 ± 8.2 vs. +0.3 ± 3.2 mg/dl, p = 0.027), but not in other MetS outcomes. In conclusion, 20 weeks of concurrent training promotes greater beneficial effects in morbidly obese patients with a high number of MetS risk factors. However, the NR prevalence for improving MetS outcomes was significantly superior in these more-diseased groups in SBP, FPG, and HDL-c, independent of their major training-induced effects.

Resultados neonatales adversos según grados de obesidad pregestacional en un hospital público del sur de Perú, 2010 a 2019

Introducción: La obesidad materna, creciente problema de salud pública mundial, se relaciona con morbimortalidad neonatal. El objetivo fue determinar los resultados neonatales adversos según los grados de obesidad pregestacional. Material y método: Estudio analítico, de cohorte retrospectiva, en gestantes de embarazo único, de parto atendido en el hospital Hipólito Unanue de Tacna Perú, durante 2010 a 2019, con recién nacido vivo, los casos fueron 5935 madres con índice de masa corporal pregestacional de 30 Kg/m2 a más, agrupadas en grado I (IMC 30-34,9 Kg/m2), II (IMC 35-39,9 Kg/m2) y III (IMC>40 Kg/m2), los controles madres con IMC de 18-24,9 Kg/m2. Se excluyeron gestantes con diabetes mellitus, preeclampsia, eclampsia y anomalías congénitas. Se utilizó Riesgo Relativo (RR) crudo y ajustado por edad materna, escolaridad y paridad, con intervalo de confianza al 95%. Resultados: La frecuencia de obesidad pregestacional fue 14,3% grado I, 3,8% grado II y 1% grado III. Los resultados neonatales que se asociaron fueron: peso al nacer >4000 gramos, para obesidad grado I (RRa: 1,9; IC95%:1,7-2,0), grado II (RRa: 2,0; IC95%:1,8-2,3) y grado III (RRa: 2,1; IC95%:1,7-2,5); grande para la edad gestacional para grado I (RRa: 1,6; IC95%: 1,4-1,7), grado II (RRa: 1,7; IC95%: 1,6-1,9) y grado III (RRa: 1,8; IC95%: 1,4-2,1). Conclusiones: Existe mayor riesgo de macrosomía fetal y grande para la edad gestacional a mayor grado de obesidad pregestacional materna.

Background: Maternal obesity, a growing global public health problem, is related to neonatal morbidity and mortality. The objective was to determine adverse neonatal outcomes according to degrees of pregestational obesity. Material and method: Analytical study, retrospective cohort, in pregnant women with a single pregnancy, delivery attended at the Hipolito Unanue hospital in Tacna, Peru, during 2010 to 2019, with live newborns, the cases were 5935 mothers with pre-pregnancy body mass index from 30 Kg/m2 to more, grouped in grade I (BMI 30-34.9 Kg/m2), II (BMI 35-39.9 Kg/m2) and III (BMI>40 Kg/m2), the control mothers with a BMI of 18-24.9 Kg/m2. Pregnant women with diabetes mellitus, preeclampsia, eclampsia and congenital anomalies were excluded. Crude Relative Risk (RR) was used, adjusted for maternal age, schooling and parity, with a 95% confidence interval. Results: The frequency of pre-pregnancy obesity was 14.3% grade I, 3.8% grade II and 1% grade III. The associated neonatal outcomes were: birth weight >4000 grams, for grade I obesity (RRa: 1.9; 95% CI: 1.7-2.0), grade II (RRa: 2.0; 95% CI: 1.8-2.3) and grade III (RRa: 2.1; CI95%: 1.7-2.5); large for gestational age for grade I (RRa: 1.6; 95% CI: 1.4-1.7), grade II (RRa: 1.7; 95% CI: 1.6-1.9) and grade III (RRa: 1.8; CI95%: 1.4-2.1). Conclusions: There is an increased risk of fetal macrosomia and large for gestational age with a higher degree of maternal pregestational obesity.

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: A controlled clinical study.

BACKGROUND: Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion. OBJECTIVES: To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study. METHODS: Seventy-three adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n = 34) followed-up during a 6-months dietary programme, and Gastroplasty group (GG; n = 39) evaluated immediately before, 3 and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the four basic tastes were assessed. Two-way mixed model and sign test were applied. RESULTS: Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p < .001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p < .05). CONCLUSION: After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.