IS THERE ANY CHANGE IN PHENOTYPIC CHARACTERISTICS COMPARING 5 TO 10 YEARS OF FOLLOW-UP IN OBESE PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS?

NONINO, Carla Barbosa; OLIVEIRA, Bruno Affonso Parenti de; CHAVES, Raoana Cássia Paixão; SILVA, Luciana Tabajara Parreiras e; PINHEL, Marcela Augusta de Souza; FERREIRA, Flávia de Campos; ROCHA, Gabriela da Costa; DONADELLI, Simara Paganini; MARCHINI, Julio Sergio; SALGADO-JUNIOR, Wilson; NICOLETTI, Carolina Ferreira

doi:10.1590/0102-672020190001e1453

Acessibilidade / Reportar erro

Brasil

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • ABCD, arq. bras. cir. dig. 32 (03) • 2019 • https://doi.org/10.1590/0102-672020190001e1453 copy

IS THERE ANY CHANGE IN PHENOTYPIC CHARACTERISTICS COMPARING 5 TO 10 YEARS OF FOLLOW-UP IN OBESE PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS?

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

HEADINGS:
Obesity; Bariatric surgery; Nutritional deficiencies; Weight regain

Colégio Brasileiro de Cirurgia Digestiva Av. Brigadeiro Luiz Antonio, 278 - 6° - Salas 10 e 11, 01318-901 São Paulo/SP Brasil, Tel.: (11) 3288-8174/3289-0741 - São Paulo - SP - Brazil
E-mail: revistaabcd@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence:
Carla Barbosa Nonino E-mail: carla@fmrp.usp.br

		Weight (kg)			BMI (kg/m²)
	n	Mean±SD	∆%	n	Mean±SD	∆%
Preoperative	409	134.3±23.5		396	50.5±8.0
1 year PO	268	90.1±18.4^a	-33.7	264	33.6±6.3^a	-33.8
2 years PO	205	85.9±18.0^a,b	-5.5	204	32.1±5.8^a,b	-5.4
3 years PO	171	87.0±17.7^a	1.4	172	32.4±5.7^a	1.3
4 years PO	130	88.3±18.2^a	2.3	129	33.0±5.8^a	2.3
5 years PO	85	88.7±16.7^a	2.2	83	33.2±5.4^a	1.8
10 years PO	27	95.4±19.3^a,c	7.5	27	36.317.0^a,c	4.1

		Glycemia			TC			TG			LDLc			HDLc
		(mg/dl)			(mg/dl)			(mg/dl)			(mg/dl)			(mg/dl)
	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)
Preoperative	166	108.0±38.7	40	360	182.4±40.0	31	357	146.8±73.1	38	351	114.1±33.2	29	358	40.4±10.7	31
1 year PO	161	85.1±10.5^a	6.2	332	159.9±30.5^a	9.3	332	86.4±34.6^a	4.8	325	95.5±25.0^a	8.9	326	47.2±10.0^a	8
2 years PO	150	84.5±11.8^a	6.7	147	165.2±33.8^a	14	148	80.5±36.0^a	4.1	146	94.8±26.8^a	7.5	147	54.2±13.0^a,b	3.4
3 years PO	136	83.9±9.9^a	5.1	130	166.6±32.4^a	12	130	78.5±33.0^a	4.6	130	98.1±27.1^a	10	130	53.3±11.4^a,b	3.8
4 years PO	104	84.6±11.5^a	5.8	100	174.9±37.8^b,c	27	100	81.9±38.3^a	9	101	103.8±29.9^a,b,c	19	101	54.3±12.6^a,b	5.9
5 years PO	64	83.9±13.2^a	4.7	61	175.3±37.0^b	23	62	75.8±29.8^a	3.2	62	105.5±29.6^a,b,c	18	62	54.5±12.1^a,b	3.2
10 years PO	27	85.1±7.9^a	3.7	27	164.2±50.2	29.6	27	81.4±36.4^a	7.4	27	98.1±32.3	29.6	27	54.7±14.9^a	7.4

		Iron			LIBC			Ferritin			Hemoglobin			Hematocrit
		(ug/dl)			(ug/dl)			(ng/ml)			(g/dl)			(%)
	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)
Preoperative	360	74.8±27.6	9.2	346	248.1±66.3	35.8	328	161.4±133.0	1.8	434	13.3±1.7	15.7	441	40.5±4.9	11.6
1 year PO	337	84.3±35.3^a	8.9	243	218.5±79.3^a	31.1	315	134.4±133.6^a	3.5	336	12.9±1.9^a	28	335	39.5±4.2^a	16.7
2 years PO	152	83.4±38.6^a	10.5	133	261.9±96.6^b	43.8	143	92.1±103.7^a,b	7	148	12.7±2^a	31.8	148	39.0±4.4^a	17.6
3 years PO	137	75.2±35.3^b,c	17.5	122	273.1±97.3^a,b	43.8	129	76.2±104.9^a,b	14.7	139	12.3±2.3^a,b	34.5	139	37.6±5.5^a,b,c	24.5
4 years PO	99	80.5±39.2	14.1	89	267.2±90.6^b	39.4	95	58.7±87.6^a,b,c	8.4	104	12.4±1.8^a,b	35.6	104	38.0±3.7^a,b	19.2
5 years PO	65	72.6±33.4^b,c	18.5	68	275.2±91.4^a,b	50	60	40.0±53.5^a,b,c	13.3	70	12.4±1.4^a,b	38.6	70	37.4±5.5^a,b,c	20
10 years PO	27	75.4±49.4^a,e	18.5	27	243.8±114.8^d,e	44.4	27	54.1±86.4^a,b,c	11.1	27	12.7±2.2^a	22.2	27	38.7±5.9^a,b	22.2

		Albumin			Total protein			Vitamin B12			Folic acid
		(g/dl)			(g/dl)			(Ng/ml)			(Pg/ml)
	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)
Preoperative	380	4.1±1.9	5.8	345	7.0±0.5	3.5	308	408.2±201.0	4.2	315	10.1±5.4	1.3
1 year PO	328	4.2±2.1	4.0	296	6.7±0.5^a	3.7	294	346.4±202.6^a	6.8	278	15.1±6.5^a	0.7
2 years PO	152	4.1±0.3	2.6	148	6.8±0.4^a	4.1	142	315.1±171.6^a	12	143	14.9±6.7^a	0
3 years PO	135	4.4±3.2	1.5	131	6.7±0.5^a	3.8	122	332.2±189.0^a	11.5	126	15.0±6.3^a	0.8
4 years PO	100	4.1±0.2	2	94	6.7±0.5^a	3.2	94	284.3±178.9^a,b	20.2	90	15.8±6.8^a	2.2
5 years PO	58	4.2±0.2	1.7	59	6.7±0.4^a	1.7	62	310.4±186.0^a	17.7	62	16.3±6.3^a	0
10 years PO	27	4±0.4	3.7	27	6.5±0.7^a	11.1	27	379.8±255.6	11.1	27	18.3±6.5 ^a	3.7

		Calcium			Sodium			Potassium			Zinc			Magnesium			Inorganic phosphorus
		(mg/dl)			(meq/l)			(meq/l)			(ug%)			(meq/l)			(mg/dl)
	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean ±SD	(%)
Preoperative	287	9.3±0.8	7.3	405	138.5±7.0	8.4	403	4.2±0.4	3.2	311	88.7±14.7	1.0	320	1.6±0.2	14.1	324	4.4±4.9	0.6
1 year PO	314	9.3±0.6	6.4	334	140.7±3.0^a	1.2	328	4.2±0.4	1.5	224	83.0±12.6^a	0.6	319	1.7±0.2^a	11.3	302	4.2±1.6	0.3
2 years PO	146	9.3±0.7	8.2	152	140.0±3.5^a	2.0	151	4.3±0.4^a	1.3	123	80.4±12.0^{a, b}	0.7	142	1.6±0.2	8.5	139	4.2±3.0	0
3 years PO	131	9.2±0.7	10.7	139	139.9±2.7^a	2.2	133	4.3±0.3^a	0.8	111	80.2±11.0^a,b	0	124	1.6±0.2	5.6	127	3.9±0.6	0
4 years PO	99	9.2±0.7	9.1	112	139.8±2.6^a	3.6	102	4.3±0.4^a,b	0	87	82.7±13.4^a	1.1	88	1.6±0.2	3.4	90	4.3±3.4	0
5 years PO	59	9.0±0.6^a,b,c	10.2	77	140.5±3.0^a	2.6	63	4.3±0.4	1.6	58	82.9±11.3^a	0	59	1.7±0.2^a,c	5.1	59	4.5±4.0	0
10 years PO	27	9.2±0.5^d	7.4	27	139.1±3.2	3.7	27	4.3±0.4	3.7	27	89.3±11.0	0	27	1.5±0.2^b,d	14.8	27	4.4±3.8	7.4

	Uric acid			Urea				Creatinine			Gama GT			AST			ALT
		(mg/dl)			(mg/dl)			(mg/dl)			(mg/dl)			(u/l)			(u/l)
	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)	n	Mean±SD	(%)
Preoperative	371	6.3±1.7	70.5	423	25.9±8.6	1.2	416	0.8±0.2	1.7	365	44.1±33.4	23.4	384	26.1±16.4	18.5	379	33.5±23.2	3.7
1 year PO	326	4.4±1.3^a	32.4	325	24.7±8.9^a	1.2	327	0.8±0.4	0.9	313	24.8±14.4^a	5.8	329	22.9±13.8^a	2.7	330	23.3±15.8^a	0
2 years PO	149	4.2±1.2^a	21.5	150	26.7±8.0^b	1.3	149	0.8±0.2	0	145	26.4±21.5^a	8.3	151	23.0±12.0^a	6.6	151	22.8±11.9^a	0
3 years PO	130	4.0±1.2^a	9.2	136	26.4±9.5	2.2	133	0.7±0.1^a	0	122	26.0±21^.0a	4.9	131	22.4±9.5^a	6.9	130	21.5±21.6^a	0
4 years PO	96	3.9±1.2^a	10.4	101	26.0±7.7	0	99	0.8±0.1	0	97	24.6±15.0^a	4.1	100	22.8±7.9^a	8	101	19.0±9.8^a,b	0
5 years PO	59	3.9±1.2^a,b	13.6	62	25.0±9.4	1.6	61	0.9±0.8^d	1.6	60	26.0±24.0^a	6.7	63	22.3±5.3^a	6.3	63	18.5±9.0^a	0
10 years PO	27	4.2±1.4^a	11.1	27	27.9±9.4	0	27	0.7±0.1^a	0	27	25.6±4.6^a	3.7	27	25.0±10.7	7.4	27	20.2±8.0^a	0

	n	Energy (kcal/day)	Protein (g/day)	Carbohydrate (g/day)	Lipid (g/day)	Calcium (mg/day)	Iron (mg/day)	Vitamin B12 (mg/day)	Folic acid (mg/day)
Preoperative	72	1505.6±582.7	73.3±27.5	200.9±90.2	47.4±21.9	495.7±227.6	12.6±5.9	3.5±2.1	297.7±146.9
1 year PO	72	965.2±274.6^a	43.6±13.6^a	131.4±51.2^a	30.8±11.0^a	596.8±248.5^a	6.5±1.7^a	2.2±1.3^a	218.3±121.4^a
2 years PO	72	1005.8±365.4^a	46.0±16.5^a	133.6±56.5^a	33.3±14.9^a	487.8±258.8^b	6.9±2.7^a	2.1±1.2^a	184.9±109.6^a
3 years PO	72	981.4±336.6^a	45.2±18.8^a	126.2±40.4^a	34.1±16.5^a	480.1±258.7^b	7.0±2.9^a	4.9±10.5^a,b,c	202.9±116.2^a
4 years PO	72	949.3±343.2^a	46.1±15.0^a	122.9±54.0^a	31.8±15.2^a	421.8±205.9^b	7.1±2.5^a	2.7±3.6^a,d,e	193.7±85.9^a
5 years PO	72	1014.2±338.4^a	44.8±20.3^a	130.4±45.6^a	37.7±15.4^a	465.8±286.0^b	6.8±2.2^a	2.0±1.3^a,e	186.8±110.5^a
10 years PO	27	1300.9±581.0^b,c,d,e	59.7±26.1^b	164.8±90.7	44.8±23.1^b,c,d,e	528.1±355.5^e,f	8.3±4.4	3±2.6^f	109.7±85.9^a,b,c,d,e,f