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. BACKGROUND patients AIMS profiles METHODS 7 ≥20% 20 (≥20 loss. . loss) glycemic lipid evaluation minimum weight, , weight) performed RESULTS 46391209 46 39 12 09 46.39±12.0 years 4010411 40 10 4 11 40.10±4.1 kgm2 kgm kg m2 m 336 3 36 3.3 263039 26 30 9 26.30±3. kg/m 2966466 29 66 29.66±4.6 1876 18 6 18±7. months 9108118 91 08 8 91.08±11.8% 885565 85 5 65 8.85±5.6 r=0.351 r0351 r 0 351 (r=0.351 p<0.011, p0011 p p<0.011 011 p<0.011) Cpeptide C peptide r=0.303 r0303 303 (r=0.303 Creactive reactive r=0.402 r0402 402 (r=0.402 p<0.001, p0001 p<0.001 001 p<0.001) r=0.435 r0435 r= 0.435 435 (r=-0.435 regained CONCLUSIONS However analyzed ≥20 2 (≥2 4639120 1 46.39±12. 401041 40.10±4. 33 3. 26303 26.30±3 296646 29.66±4. 187 18±7 910811 91.08±11.8 88556 8.85±5. r=0.35 r035 35 (r=0.35 p001 p<0.01 01 r=0.30 r030 (r=0.30 r=0.40 r040 (r=0.40 p000 p<0.00 00 r=0.43 r043 0435 0.43 43 (r=-0.43 ≥2 (≥ 463912 46.39±12 40104 40.10±4 2630 26.30± 29664 29.66±4 18± 91081 91.08±11. 8855 8.85±5 r=0.3 r03 (r=0.3 p00 p<0.0 r=0.4 r04 (r=0.4 043 0.4 (r=-0.4 ≥ ( 46391 46.39±1 4010 40.10± 263 26.30 2966 29.66± 9108 91.08±11 885 8.85± r=0. r0 (r=0. p0 p<0. 04 0. (r=-0. 4639 46.39± 401 40.10 26.3 296 29.66 910 91.08±1 88 8.85 r=0 (r=0 p<0 (r=-0 463 46.39 40.1 26. 29.6 91.08± 8.8 (r= p< (r=- 46.3 40. 29. 91.08 8. (r 46. 91.0 91.

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 RACIONAL pósoperatório pós operatório préoperatórias pré operatórias pacientes OBJETIVOS MÉTODOS 7 =20% 20 (=20 perdido. perdido . perdido) glicêmico avaliação préoperatório, préoperatório operatório, menor ponderal multivariada RESULTADOS 46391209 46 39 12 09 46.39±12.0 anos 4010411 40 10 4 11 40.10±4.1 kgm2 kgm kg m2 m kg/m2 336 3 36 3,3 263039 26 30 9 26.30±3. Kgm2 Kgm Kg Kg/m 2966466 29 66 29.66±4.6 1876 18 6 18±7. meses PEP 9108118 91 08 8 91.08±11.8% 885565 85 5 65 8.85±5.6 r=0.351 r0351 r 0 351 (r=0.351 p<0.011, p0011 p p<0.011 , 011 p<0.011) r=0.303 r0303 303 (r=0.303 r=0.402 r0402 402 (r=0.402 p<0.001 p0001 001 r=0.435 r0435 r= 0.435 435 (r=-0.435 p<0.001, CONCLUSÕES entanto préoperatórios operatórios =20 2 (=2 4639120 1 46.39±12. 401041 40.10±4. kg/m 33 3, 26303 26.30±3 296646 29.66±4. 187 18±7 910811 91.08±11.8 88556 8.85±5. r=0.35 r035 35 (r=0.35 p001 p<0.01 01 r=0.30 r030 (r=0.30 r=0.40 r040 (r=0.40 p<0.00 p000 00 r=0.43 r043 0435 0.43 43 (r=-0.43 =2 (= 463912 46.39±12 40104 40.10±4 2630 26.30± 29664 29.66±4 18± 91081 91.08±11. 8855 8.85±5 r=0.3 r03 (r=0.3 p00 p<0.0 r=0.4 r04 (r=0.4 043 0.4 (r=-0.4 = ( 46391 46.39±1 4010 40.10± 263 26.30 2966 29.66± 9108 91.08±11 885 8.85± r=0. r0 (r=0. p0 p<0. 04 0. (r=-0. 4639 46.39± 401 40.10 26.3 296 29.66 910 91.08±1 88 8.85 r=0 (r=0 p<0 (r=-0 463 46.39 40.1 26. 29.6 91.08± 8.8 (r= p< (r=- 46.3 40. 29. 91.08 8. (r 46. 91.0 91.

Introduction: anthropometric indicators are easy to apply and can help identify the accumulation of visceral fat, which favors the occurrence of cardiovascular events, increasing morbidity and mortality from chronic degenerative diseases. Objective: to evaluate the accuracy of anthropometric indicators for the location of abdominal fat in determining visceral adiposity. Subjects/Methods: cross-sectional study conducted among patients attending outpatient, of both sexes, aged over 20 years. Evaluated: Waist Circumference (WC), Waist-Hip Ratio (WHR), waist-to- stature ratio (CER), conicity index (CI); Sagittal Abdominal Diameter (DAS); Coronal Diameter (DC); Mass Index (BMI), percentage of body fat (% BF); Visceral Adiposity (AV/AS) predicted by the formula , fasting glucose , total cholesterol (TC), Low Density Lipoprotein (LDL), high density lipoprotein (HDL), Very Low Density lipoprotein (VLDL) and Triglycerides (TG). Results: 129 patients were included, mean age 51, 06 + 14.02 years and a higher prevalence of adults (72,9%) and female (75,2%). CC 102,9 (+ 10,82 ), CI 2,08 (+ 0,13), and the AV/AS 1,03 (+ 0,16), showed high values with statistical significance among men, p<0.001 . The same occurred with the CT (212,41 + 46,4), HDL (50,15 + 13,24) and LDL (135,62 + 40,16) among women, p<0.05. The CC, RCE, DAS and DC showed an inverse and significant correlation with the AV/AS: r = -0,364; -0,457; -0,403; -0,296; -0,475; respectively, p<0.001. However, best explained the variance in visceral obesity were the DC (R² = 0.77), CQ (R² = 0.64) and CERs (R² = 0.59). Discusión/Conclusion: the DC and CERs were the best predictors anthropometric measures of visceral obesity.

Introducción: los indicadores antropométricos son fáciles de aplicar y pueden ayudar en la identificación de la acumulación de grasa visceral, lo que favorece la aparición de eventos cardiovasculares, así como, el aumento de la morbilidad y mortalidad por enfermedades crónicas. Objetivo: evaluar la exactitud de los indicadores antropométricos de distribución de la grasa abdominal para determinar la adiposidad visceral. Sujetos/Métodos: estudio transversal realizado con pacientes ambulatorios, de ambos sexos, mayores de 20 años. Fueron evaluados: circunferencia de la cintura (CC); relación cintura-cadera (WHR); cintura-altura (CER); índice Taper (CI); diámetro abdominal sagital (DAS); (DC) de diámetro coronal; índice de masa corporal (IMC); porcentaje de grasa corporal (% GC); adiposidad visceral (AV/AS) predicha por la fórmula; glucosa en sangre en ayunas; colesterol total (TC); lipoproteína de baja densidad (LDL); lipoproteína de alta densidad (HDL); lipoproteínas de muy baja densidad (VLDL) y triglicéridos (TG). Resultados: se evaluaron 129 pacientes, edad media 51, 06 + 14,02 años y una mayor prevalencia de adultos (72,9%) y mujeres (75,2%). CC 102,9 (+ 10,82), HF 2,08 (± 0,13) y AV/AS 1,03 (+ 0,16), mostraron valores altos con significación estadística entre los hombres, p < 0,001. Lo mismo ocurrió con la CT (+ 46,4 212,41), HDL (50,15 + 13,24) y LDL (135,62 + 40,16) entre las mujeres, p < 0,05. DC, RCE, DAS y DC mostraron una correlación inversa y significativa con la AV/AS: r = -0,364; -0.457; -0.403; -0.296; -0.475, respectivamente, p < 0,001. Sin embargo, que mejor explicó la varianza de la obesidad visceral fueron el DC (R² = 0,77), CQ (R² = 0,64) y RCE (R² = 0,59). Discusión/Conclusión: la DC y el CER fueron los mejores predictores para las mediciones antropométricas de la obesidad visceral.