RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

Abstract Introduction: Gene expression analyses from peripheral blood mononuclear cells (PBMC) and white adipose tissue are conflicting. It seems that results from single tissue are not enough to explain how changes affect humans as a complex biological system. Objective: The aim of this study was to compare, from obesity subjects, PBMC and white adipose tissue gene expression that regulates adipogenesis (perilipin 1 [PLIN1], adrenoreceptor beta 3 [ADRB3] and peroxisome proliferator-activated receptor [PPARG2]) and the energy metabolism (uncoupling protein UCP1, UCP2 and UCP3) process. Methods: This study enrolled 35 obese patients, with a body mass index (BMI) > 40 kg/m2 (obesity group [OG]), and ten eutrophic health subjects, 18 > BMI > 24.9 kg/m2 (control group [CG]). Anthropometric and body composition data were assessed at recruitment using standardized protocols. Samples of peripheral blood and subcutaneous adipose tissue (biopsy) were collected to analyze gene expression by RT-qPCR technique. For statistical analysis, we used the Shapiro-Wilk test and Wilcoxon tests by the SPSS software version 20.0; a p < 0.05 significance level was adopted. Results: There were significant differences of PLIN1, ADRB3, PPARG2 and UCP3 expression between blood against adipose tissue samples, showing that these genes are upregulated in adipose tissue. UCP2 expression was upregulated in PBMC. Conclusion: The PLIN1, ADRB3, PPARG2 and UCP3 genes were preferentially expressed in adipose tissue. However, UCP2 was upregulated in PBMC, suggesting that this gene may be assessed in a peripheral blood cell, which is easily accessible, safe and practical.

Resumen Introducción: la expresión de genes de células mononucleares de sangre periférica y de tejido adiposo blanco es contradictoria. Los resultados del tejido no son suficientes para explicar cómo afectan los cambios al ser humano como un sistema biológico complejo. Objetivo: el objetivo de este estudio fue comparar, en individuos con obesidad, la expresión de genes que regulan los procesos de adipogénesis (PLIN1, ADRB3 y PPARg2) y el metabolismo energético (UCP1, UCP2 y UCP3) en sangre y tejido adiposo blanco. Métodos: este estudio incluyó a 35 pacientes con obesidad e índice de masa corporal (IMC) > 40 kg/m2 en el grupo obesidad (GO) y a diez personas sanas con peso normal (18 > IMC > 24,9 kg/m2) en el grupo control (GC). Los datos antropométricos y de composición corporal fueron obtenidos por protocolos estandarizados. Se recogieron muestras de sangre periférica y tejido adiposo subcutáneo (biopsia) para analizar la expresión génica por la técnica de RT-qPCR. Para el análisis estadístico se utilizaron el test de Shapiro-Wilk y pruebas de Wilcoxon mediante el programa SPSS versión 20.0 (p < 0,05). Resultados: no se encontraron diferencias significativas en la expresión de genes PLIN1, ADRB3, PPARg2 y UCP3 entre la sangre y las muestras de tejido adiposo, mostrando que estos genes son regulados positivamente en el tejido adiposo. La expresión del gen UCP2 fue regulada positivamente en sangre. Conclusión: los genes PLIN1, ADRB3, PPARg2 y UCP3 se expresaron de forma preferente en el tejido adiposo. Sin embargo, el gen UCP2 se reguló positivamente en sangre, lo que sugiere que puede ser evaluado en sangre periférica, que es fácilmente accesible, de forma segura y práctica.

Introduction: Informatization contributes to the integration among various sectors, cost reduction, and improved quality of services. This study aimed to assess the impact on cost/benefit of the integration of electronic prescription of pediatric formulas and enteral diets in the respective production areas in a hospital. Methods: We analyzed the quantitative consumption and financial cost of the products corresponding to 80% of the budget ceiling for the annual programming of each modality during 2 consecutive months in two steps, i.e., before and after the implementation of the new module. Results: A more effective control of the quantities produced and of the final products dispensed was observed, reducing both the traceable and untraceable demands (an 85% reduction in financial terms from R$ 3770.25/months before to R$ 566.73/month after). Conclusion: The change represented a technological innovation that improved the quality of the service provided and contributed to waste reduction.

Introducción: La informatización contribuye para la integración entre distintos sectores, la reducción de costes y la mejora de la calidad de los servicios. Este estudio tuvo como objetivo evaluar el impacto sobre los costes y beneficios que ofrece la integración de la receta electrónica de formulaciones pediátricas y la alimentación enteral con sus respectivas zonas de producción de un hospital. Métodos: Se analizaron el consumo cuantitativo y financiero de los productos correspondientes al 80% del límite máximo del presupuesto de la programación anual de cada modalidad durante 2 meses consecutivos en dos etapas, antes y después de la implementación del nuevo módulo. Resultados: Hubo un control más efectivo de las cantidades producidas, dio a conocer los productos finales, reduciendo las demandas tanto trazables y no rastreables (reducción de 85% en términos financieros, de R$ 3770,25 / mes por adelantado y R$ 566,73 / mes más tarde). Conclusión: El cambio representó una innovación tecnológica que proporciona una mejor calidad de servicio y ha contribuido a la reducción de residuos.

Introduction: Energy balance is influenced by the oxidation of macronutrients (proteins, carbohydrates and lipids). Objective: To characterize substrate utilization in normal weight and obese. Subjects and Methods: Bioelectrical impedance analysis and indirect calorimetry were used to determine the oxidation of carbohydrates and lipids in hospitalized patients. Subjects were divided into three groups: group 1: BMI 18.5-24.9 kg/m, group 2: BMI 25-29.9 kg / m and Group 3: BMI> 30 k/m². Groups of individuals were compared using ANOVA and, in some cases, after the Dunn test was applied (p <0.05 were considered significant). Results: 38 individuals (11 men and27 women) with a mean age of 44.3 ± 16.5 years ofwhich 18 were eutrophic, 10 overweightand10 obese. Obese subjects had higher resting energy expenditure than normal individuals. Obese and non-obese individuals oxidized similar amounts of carbohydrates and lipids. Conclusions: BMI was not associated with the oxidation oflipids and carbohydrates in hospitalized patients. The amount offat mass is associated with the total amount of carbohydrate and lipid oxidation.

Introducción: El balance de energía se ve influenciado por la oxidación de macronutrientes (proteínas, carbohidratos y lípidos). Objetivo: Caracterizar la utilización de sustratos en sujetos con peso normal y obesos. Metodología: se realizó una impedancia bioeléctrica y una calorimetría indirecta para determinar la oxidación de carbohidratos y lípidos de pacientes hospitalizados. Los sujetos fueron divididos en tres grupos, el grupo 1: IMC 18,5-24,9 kg / m2, grupo 2: IMC 25-29.9 kg / m2 y el grupo 3: IMC> 30 kg / m2. Los grupos de individuos se compararon mediante la prueba de ANOVA y, en algún caso, después de la prueba se aplicó el Dunn (p< 0,05 consi-derado significativo). Resultados: Se estudiaron 38 personas (11 hombres y 27 mujeres) con una edad media de 44,3±16,5 años; 18 normales, 10 con sobrepeso y 10 obesos. Los sujetos obesos tenían un mayor gasto energético en reposo que los individuos normales. Obesos y no obesos oxidan cantidades similares de carbohidratos y lípidos. Conclusiones: El índice de masa corporal no se asoció con la oxidación de los lípidos y carbohidratos en pacientes hospitalizados. La cantidad de masa sin grasa se asocia con la cantidad total de hidratos de carbono y oxidación de lípidos.

OBJETIVO: A dieta cetogênica é empregada como uma terapia alternativa para o tratamento da epilepsia em pacientes com epilepsia refratária e simula as alterações bioquímicas de jejum. Neste trabalho, verificouse o impacto nutricional da dieta cetogênica em crianças com epilepsia refratária. MÉTODOS: Os dados sobre o estado nutricional (bioquímica, alimentar e medidas antropométricas), a frequência de crises e os eventos adversos de crianças acompanhadas durante 36 meses foram coletados de prontuários médicos e visitas ambulatoriais. RESULTADOS: Vinte e nove crianças iniciaram o tratamento; após um mês, 75,8% apresentaram redução das crises. Em seis meses, 48,3% dos pacientes tiveram pelo menos 90,0% de redução na frequência de crises, e, desses, 50,0% obtiveram o controle completo das crises. Aos doze meses, oito pacientes continuaram a apresentar Resultados positivos, e, desses, sete permaneceram em dieta cetogênica durante 24 meses. Observouse melhora do estado nutricional aos 24 meses de tratamento, especialmente em termos de peso, o que indica a recuperação da condição peso para altura. Não houve mudanças significativas nos índices bioquímicos analisados (colesterol total e de componentes, triglicerídeos, albumina, proteína total, creatinina, glicemia, transaminase glutâmico oxalacética sérica e transaminase glutâmico pirúvico sérica). Os níveis de colesterol aumentaram significativamente no primeiro mês, mas diminuíram nos seis meses seguintes e, posteriormente, se mantiveram dentro dos valores de referência. CONCLUSÃO: Os pacientes em uso da dieta cetogênica clássica por pelo menos 24 meses apresentaram melhora de peso e cerca de um terço dos pacientes conseguiu uma redução significativa da frequência de crises, com alguns pacientes completamente livres delas.

OBJECTIVE:The ketogenic diet is used as a therapeutic alternative for the treatment of epilepsy in patients with refractory epilepsy. It simulates biochemical changes typical of fasting. The present study verified the nutritional impact of the ketogenic diet on children with refractory epilepsy. METHODS: Nutritional status data (dietary, biochemical and anthropometric measurements), seizure frequency, and adverse events were collected from the medical records and during outpatient clinic visits of children over a period of 36 months. RESULTS: Of the 29 children who initiated the ketogenic diet, 75.8% presented fewer seizures after one month of treatment. After six months, 48.3% of the patients had at least a 90.0% decrease in seizure frequency, and 50.0% of these patients presented total seizure remission. At 12 months, eight patients continued to show positive results, and seven of these children remained on the ketogenic diet for 24 months. There was an improvement of the nutritional status at 24 months, especially in terms of weight, which culminated with the recovery of proper weightforheight. There were no significant changes in biochemical indices (total cholesterol and components, triglycerides, albumin, total protein, creatinine, glycemia, serum aspartate transaminase and serum alanine transaminase). Serum cholesterol levels increased significantly in the first month, fell in the following six months, and remained within the normal limits thereafter. CONCLUSION: In conclusion, patients on the classic ketogenic diet for at least 24 months gained weight. Moreover, approximately one third of the patients achieved significant reduction in seizure frequency, and some patients achieved total remission.