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Evolução do padrão alimentar a longo prazo após cirurgia bariátrica
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Introdução: Embora a Cirurgia Bariátrica (CB) seja reconhecida como o tratamento mais eficaz no combate à obesidade, pouco se sabe sobre as alterações a longo prazo dos hábitos e padrões alimentares dos indivíduos intervencionados, nomeadamente ao nível do consumo alimentar e número de refeições realizadas e de que forma estas alterações poderão influenciar os parâmetros clínicos e antropométricos. Pretendeu-se caraterizar a evolução do padrão alimentar e dos parâmetros clínicos e antropométricos 5 anos após a realização de CB.
Material e Métodos: Trata-se de um estudo observacional, longitudinal, retrospetivo e analítico. A população consistiu nos indivíduos submetidos a qualquer tipo de CB até Dezembro de 2010, no Hospital de Santa Maria (HSM). Foi administrado presencialmente um questionário com dados sociodemográficos, dados clínicos e antropométricos e aplicados três instrumentos validados para a população portuguesa: o International Physical Activity Questionnaire (IPAQ), o Questionário Alimentar às 24h anteriores (Recall 24h) e o Questionário de Frequência Alimentar (QFA).
Resultados: Dos 73 elementos constituintes da população-alvo, aceitaram participar 45 e a amostra final foi constituída por 31 indivíduos. Após um seguimento médio de 5 anos, verificou-se uma evolução positiva em todas as comorbilidades estudadas, com diminuição de 25,7% na prevalência da hipertensão arterial (HTA), 16,1% na diabetes mellitus tipo 2 (DM2), 3,2% na dislipidémia e 29% na apneia de sono. Adicionalmente, ocorreu uma diminuição do peso médio na ordem dos 34kg e do Índice de Massa Corporal (IMC) na ordem dos 12,2kg/m2, com um ligeiro aumento 15 meses após a cirurgia. 64,5% da amostra atingiu uma percentagem de Excesso de Peso Perdido (%EPP) superior ou igual a 50%. Relativamente à prática de atividade física, 77,4% da amostra apresentava um nível de atividade física de intensidade baixa, verificando-se igualmente uma tendência para valores mais baixos de variáveis antropométricas com a prática de atividade física de intensidade média. Verificou-se uma diminuição significativa do consumo alimentar (3155,5kcal para 1930,6kcal), com diminuição da ingestão de 57g de proteína, 144,1g de hidratos de carbono e 50,4g de lípidos entre os dois momentos. A redução da ingestão de colesterol e de ácidos gordos monoinsaturados a serem determinantes para o peso e IMC atual. Para além disso, foi possível observar um consumo deficitário de vitamina D, Folato, Potássio e Cálcio.
Conclusões: Os resultados do presente estudo vêm contribuir para a evidência acumulada de que a CB é atualmente o tratamento mais eficaz no combate à obesidade, contudo não é garantia de sucesso, sendo que os pacientes necessitam de acompanhamento a longo prazo por parte da equipa multidisciplinar. A amostra estudada apresentou reduções de peso significativas, taxas elevadas de melhoria e resolução das comorbilidades estudadas e diminuição do consumo alimentar entre os dois momentos estudados.
Background: Although bariatric surgery is recognized as the most effective strategy in the treatment of obesity, little is known about the long-term changes of eating habits and patterns of intervened patients, particularly in terms of food consumption and number of meals and how these changes may influence the clinical and anthropometric parameters. The aim of this study was to characterize the evolution of dietary patterns and clinical and anthropometric parameters 5 years after performing bariatric surgery. Methods: This was an observational, longitudinal, retrospective and analytical study. The population consisted of patients that undergone any type of bariatric surgery until December 2010, at the Hospital of Santa Maria. A questionnaire with demographic data, clinical and anthropometric data and three instruments validated for the Portuguese population: the International Physical Activity Questionnaire (IPAQ), the Recall 24 and the Food Frequency Questionnaire (FFQ ) were applied. Results: Of the 73 individuals of the target population, 45 agreed to participate and the final sample consisted of 31 individuals. There was a positive trend in all studied comorbidities, with a decrease of 25,7% in the prevalence of hypertension, 16,1% in type 2 diabetes mellitus, dyslipidaemia 3,2% and 29% in sleep apnea. In addition, there was a decrease in the average weight of around 34kg and BMI of 12,2kg/m2, with a slight increase recorded after 15 months of surgery. 64,5% of the sample had reached a percentage of excessive weight loss greater than or equal to 50%. Regarding physical activity, 77,4% had a level of physical activity of low intensity. There was a significant decrease in food consumption (3155,5kcal to 1930,6kcal), with a decrease of protein intake, 57g, 144,1g of carbohydrates and lipids 50,4g between the two moments. The reduction of cholesterol intake and monounsaturated fatty acids was determinant for the current weight and BMI. In addition, we observed a deficient intake of vitamin D, folate, potassium and calcium. Conclusions: The results of this study contributes to the accumulating evidence that bariatric surgery is currently the most effective strategy in treatment of obesity, but it is no guarantee of success, and patients require long-term monitoring by the multidisciplinary team. The sample showed significant reductions in weight, high rates of improvement and resolution of comorbidities studied and decreased food intake between the two periods studied.
Background: Although bariatric surgery is recognized as the most effective strategy in the treatment of obesity, little is known about the long-term changes of eating habits and patterns of intervened patients, particularly in terms of food consumption and number of meals and how these changes may influence the clinical and anthropometric parameters. The aim of this study was to characterize the evolution of dietary patterns and clinical and anthropometric parameters 5 years after performing bariatric surgery. Methods: This was an observational, longitudinal, retrospective and analytical study. The population consisted of patients that undergone any type of bariatric surgery until December 2010, at the Hospital of Santa Maria. A questionnaire with demographic data, clinical and anthropometric data and three instruments validated for the Portuguese population: the International Physical Activity Questionnaire (IPAQ), the Recall 24 and the Food Frequency Questionnaire (FFQ ) were applied. Results: Of the 73 individuals of the target population, 45 agreed to participate and the final sample consisted of 31 individuals. There was a positive trend in all studied comorbidities, with a decrease of 25,7% in the prevalence of hypertension, 16,1% in type 2 diabetes mellitus, dyslipidaemia 3,2% and 29% in sleep apnea. In addition, there was a decrease in the average weight of around 34kg and BMI of 12,2kg/m2, with a slight increase recorded after 15 months of surgery. 64,5% of the sample had reached a percentage of excessive weight loss greater than or equal to 50%. Regarding physical activity, 77,4% had a level of physical activity of low intensity. There was a significant decrease in food consumption (3155,5kcal to 1930,6kcal), with a decrease of protein intake, 57g, 144,1g of carbohydrates and lipids 50,4g between the two moments. The reduction of cholesterol intake and monounsaturated fatty acids was determinant for the current weight and BMI. In addition, we observed a deficient intake of vitamin D, folate, potassium and calcium. Conclusions: The results of this study contributes to the accumulating evidence that bariatric surgery is currently the most effective strategy in treatment of obesity, but it is no guarantee of success, and patients require long-term monitoring by the multidisciplinary team. The sample showed significant reductions in weight, high rates of improvement and resolution of comorbidities studied and decreased food intake between the two periods studied.
Descrição
Tese de mestrado, Doenças Metabólicas e do Comportamento Alimentar, Universidade de Lisboa, Faculdade de Medicina, 2017
Palavras-chave
Obesidade Cirurgia bariátrica Padrões alimentares Resultados a longo termo Teses de mestrado - 2017