ABSTRACT BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients’ biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients’ biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients’ metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.

RESUMO RACIONAL: Reganho de peso no pós-operatório de cirurgia bariátrica está diretamente relacionado à recidiva das comorbidades pré-operatórias e a um impacto negativo no perfil bioquímico desses pacientes. OBJETIVOS: avaliar o impacto metabólico do reganho de peso nas comorbidades pré-operatórias e no perfil bioquímico desses pacientes, a fim de mostrar o impacto das complicações nos desfechos metabólicos finais da cirurgia bariátrica. MÉTODOS: Estudo retrospectivo que analisou 75 mulheres no pós-operatório tardio de cirurgia bariátrica que apresentaram reganho patológico de peso (=20% do máximo de peso perdido). Foram coletados dados referentes às medidas dos perfis glicêmico, lipídico e inflamatório em três momentos distintos de avaliação: no pré-operatório, no nadir de peso (menor peso) e após o reganho ponderal. Foi realizada uma análise multivariada. RESULTADOS: A idade média foi 46.39±12.09 anos. IMC médio pré-operatório foi 40.10±4.11 kg/m2. Houve um aumento de 3,36 pontos no IMC médio entre o nadir e após reganho: de 26.30±3.9 Kg/m2 para 29.66±4.66 Kg/m2. O tempo médio para atingir o nadir foi de 18±7.6 meses, com uma %PEP de 91.08±11.8%. O tempo médio para o reganho patológico foi de 48 meses, e a média de reganho foi 8.85±5.65 kg. Houve correlação significativa entre o reganho patológico e os níveis de insulina (r=0.351; p<0.011), peptídeo C (r=0.303; p<0.011), proteína C reativa (r=0.402; p<0.001) e vitamina D (r=-0.435; p<0.001), sendo os dois últimos os mais influenciados pela porcentagem de reganho de peso. CONCLUSÕES: O reganho de peso patológico no pós-operatório de cirurgia bariátrica resulta em prejuízos ao perfil metabólico e inflamatório dos pacientes. No entanto, os benefícios bioquímicos perduram em relação aos níveis pré-operatórios dos parâmetros analisados

Abstract To review scientific evidence on the effects of a gluten-free diet on body composition and improvement of clinical and biochemical parameters of metabolic syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes - PRISMA guidelines were followed. A literature search was performed in the PubMed, ScienceDirect, Trip Database, Bireme and Scielo databases, without language restriction, until March 2021. The terms “gluten-free diet”, “obesity”, “metabolic syndrome”, and “weight loss”, and Boolean operators (AND/OR) were used. The clinical hypothesis was structured according to the acronym PICOT. Randomized clinical trials with adult and elderly humans without a diagnosis of celiac disease, consuming a gluten-free diet, evaluating associations of the effects of this diet on weight loss and metabolic syndrome components were considered eligible. To assess the risk of bias, the RoB2 was used. A total of 3,198 articles were identified and, after the screening and evaluation of pre-defined eligibility criteria, four studies were included in the qualitative analysis. Weight loss was not associated with a gluten-free diet. However, individuals under a gluten-free diet had lower mean waist circumference, fat percentage (-2.3%) and serum triglyceride levels. The impact of a gluten-free diet on metabolic syndrome parameters is still controversial. In individuals without gluten sensitivity or celiac disease, the consumption of a gluten-free diet appears to provide no nutritional benefit.

Racional: No estado nutricional comprometido, há excessiva perda muscular esquelética e diminuição da resposta inflamatória, contribuindo para o aumento da morbimortalidade e do tempo de internamento. Objetivo : Estimar a prevalência de desnutrição pela medida do músculo adutor do polegar utilizando pontos de corte para pacientes cirúrgicos sugeridos na literatura. Métodos : Estudo de corte transversal com 151 pacientes candidatos a procedimento cirúrgico de caráter eletivo. Realizou-se avaliação nutricional através das medidas antropométricas clássicas: circunferência do braço, dobra cutânea tricipital, circunferência muscular do braço, área muscular do braço corrigida, IMC e percentual de perda ponderal e pela medida do músculo adutor do polegar em ambas as mãos. Resultados : A prevalência da desnutrição nos pacientes avaliados foi elevada. Houve associação significativa entre o diagnóstico nutricional, segundo o músculo adutor do polegar, e as medidas da circunferência do braço, prega cutânea tricipital e IMC. No entanto, não se associou à circunferência muscular do braço, área muscular do braço corrigida ou ao percentual de perda de peso. Conclusão : O músculo adutor do polegar mostrou ser bom método para diagnosticar a depleção muscular e a desnutrição nos pacientes cirúrgicos.

Background - In the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay. Aim: To estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature. Methods: Cross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands. Results: The prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss. Conclusion: The adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients.

RACIONAL: A obesidade obteve aumento assustador nos últimos anos, levando essa doença à condição de epidemia global. OBJETIVO: Avaliar o estado nutricional, bem como a qualidade de vida de pacientes obesos submetidos à cirurgia bariátrica. MÉTODO: Estudo transversal realizado em obesos adultos de ambos os sexos que se submeteram à cirurgia bariátrica por técnica de Fobi-Capella há pelo menos 30 dias. Foram avaliados: idade, sexo, estado civil, profissão, peso anterior à operação, peso atual, altura, índice de massa corpórea pré-operatório e atual, porcentagem de perda ponderal e porcentagem de perda do excesso de peso, manifestações clínicas e presença de intolerâncias alimentares. RESULTADOS: A amostra foi constituída de 70 pacientes, sendo 81,4% do sexo feminino, 37,1% na faixa etária entre 30 a 39 anos, 58,6% casados, 41,4% com >12 meses de cirurgia bariátrica. Observou-se redução do índice de massa corpórea de 37,2 kg/m2 (um a três meses) para 28,9 kg/m2 (>12 meses) e consequente aumento da porcentagem de perda ponderal e da perda do excesso de peso. A manifestação clínica mais frequente foi alopecia (62,9%). A intolerância alimentar mais relatada foi em relação à carne vermelha (24%). De acordo com o questionário Baros, 50% dos pacientes foram classificados como tendo boa qualidade de vida. CONCLUSÃO: A operação de Fobi-Capella mostrou-se efetiva em promover perda ponderal gradual. A qualidade de vida foi considerada boa na maior parte dos pacientes, indicando que a operação tem impacto positivo na vida desses pacientes.

BACKGROUND: The obesity has achieved an alarming increase in recent years, which led this disease to global epidemic condition. AIM: To evaluate the nutritional status as well as the quality of life of obese patients undergoing bariatric surgery. METHODS: A transversal study was conducted with obese adults of both genders who underwent bariatric surgery by Fobi-Capella technique for at least 30 days. It was evaluated: age, gender, marital status, occupation, weight before surgery, current weight, height, preoperative and current BMI, weight loss and loss of excess weight percentages, presence of clinical manifestations and food intolerances. RESULTS: The sample consisted of 70 patients, being 81.4% female, 37.1% aged 30 to 39 years, 58.6% were married, 41.4% have undergone the bariatric surgery in the last 12 months. It was observed a reduction in BMI from 37.2 kg/m2 (one to three months) to 28.9 kg/m2 (>12 months) and consequent increase in weight loss and loss of excess weight percentages. The most frequent clinical manifestation was alopecia (62.9%). The most reported food intolerance was on the red meat (24%). According to the Baros questionnaire, 50% of patients were classified as having good quality of life. CONCLUSION: The operation of Fobi-Capella proved to be effective in promoting gradual and lasting weight loss. Quality of life was considered good in most patients, indicating that the operation had a positive impact on their lives.

FUNDAMENTO: A doença valvar pode cursar com insuficiência cardíaca (IC), anemia e disfunção renal (DR), aumentando o risco nutricional e piorando o prognóstico dos pacientes. OBJETIVO: Avaliar a prevalência de anemia e DR em pacientes portadores de valvopatias com ou sem IC, bem como estabelecer correlação com o estado nutricional. MÉTODOS: Foram avaliados 104 pacientes internados na enfermaria de valvopatias do PROCAPE/UPE, no período de ago-out/2008. Os dados foram obtidos das fichas de acompanhamento nutricional e dos prontuários. As variáveis coletadas foram: sexo, idade, estado nutricional segundo o índice de massa corpórea (IMC), presença de IC, anemia, DR. Considerou-se como anemia valores de hemoglobina < 13 g/dl nos homens e < 12 g/dl nas mulheres. A DR foi estabelecida de acordo com a taxa de filtração glomerular (TGF), sendo calculada pela fórmula proposta por Cockcroft e Gault. RESULTADOS: A prevalência de anemia e DR em pacientes com IC foi de 71,1% e de 68,8%, e nos pacientes sem IC foi de 48,1% e de 60,0%, respectivamente, com diferença estatisticamente significativa para anemia (p = 0,022). Dos pacientes, 48,1% estavam eutróficos, 26,9% com excesso de peso e 25,0% com algum grau de desnutrição. Os pacientes com IC apresentaram uma frequência maior de baixo peso (p = 0,020). O estado nutricional não apresentou associação com anemia (p = 0,117), mas apresentou associação com DR, sendo a função renal diminuída mais frequente nos pacientes com baixo peso (p = 0,000). CONCLUSÃO: Houve significância estatística quando comparamos as prevalências de desnutrição, anemia e DR entre pacientes com e sem IC.

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1% and 68.8%, and 48.1% and 60.0%, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1% were eutrophic, 26.9% had excess weight and 25.0% presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

RESUMO O objetivo deste estudo é analisar a possibilidade da utilização da perimetria computadorizada em pacientes glaucomatosos com acuidade visual inferior à 200/400. Foram examinados 33 olhos de 33 pacientes (21 com AV = CD e 12 com AV = MM), utilizando-se o programa 24-2 do perímetro da Humphrey, inicialmente com estímulo III e depois com estímulo V. Doze pacientes não conseguiram realizar nenhum dos exames (todos com AV = MM). Dezenove pacientes conseguiram realizar os dois exames, enquanto dois pacientes conseguiram realizar apenas o exame com estímulo V. Dos 19 pacientes que realizaram os dois exames, 15 (68,4%) se sentiram mais confortáveis realizando o exame com estímulo V. A conclusão deste estudo é que é possível a realização da perimetria computadorizada em pacientes glaucomatosos com defeitos avançados de campo visual e AV inferior à 20/400.

SUMMARY The purpose of this study is to investigate the possibility of using the computerized perimetry in glaucomatous patients with VA less than 20/400. Thirty three eyes of 33 patients (21 with VA = CF and 12 with VA = HM), underwent automated perimetry (Humphrey 24-2 program), initially with stimulus III and after with stimulus V. Twelve patients were not able to complete neither examinations (all of them with VA = HHM). Nineteen patients were able to complete both examinations, while two patients were able to complete only the examination with stimulus V. Among the nineteen patients that carried out both examinations, fifteen (68,4%) felt themselves more confortable during the examination with stimulus V. We conclude that computerized perimetry is possible in glaucomatous patients with advanced visual field defects and VA less than 20/400.