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Os resultados psicológicos e da expressão bioquímica das doenças associadas à obesidade mórbida antes e após cirurgia bariátrica e carências subsequentes
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Introdução: A cirurgia bariátrica foi desenvolvida para ser aplicada na perda de peso em doentes com obesidade mórbida, na tentativa de reduzir as suas comorbilidades e aumentar a sua qualidade de vida. No entanto, existe evidência de consequências nutricionais potencialmente graves em relação a este tipo de cirurgia.
Objetivo: O principal objetivo deste estudo é avaliar, nos pacientes submetidos a cirurgia bariátrica a modificação do peso corporal, do estado nutricional antes e após 6, 12 e 24 meses e do comportamento alimentar antes e após a cirurgia.
Métodos: Foi realizado um estudo retrospetivo para identificar os dados sociodemográficos (sexo, idade, profissão), comorbilidades, antropométricos (peso, IMC), bioquímicos/nutricionais (ferro, creatinina, ferritina, magnésio, potássio, sódio, fósforo, cálcio, ácido fólico, vitamina B12, zinco, triglicéridos, insulina, glicose, colesterol total, colesterol HDL, colesterol LDL, ácido úrico, vitamina D), prevalência de carências nutricionais e bioquímicas e de avaliação do comportamento alimentar (teste EDI) em 147 utentes de cirurgia bariátrica entre os anos de 2007 e 2010, nos períodos de avaliação antes da cirurgia e após 6, 12, e 24 meses da intervenção cirúrgica. Os dados foram analisados por SPSS e foram aplicados testes paramétricos (ANOVA – Repeated Measures) e não paramétricos (teste de Fisher e Spearman).
Resultados: Após a cirurgia bariátrica, a redução do peso é significativa aos 6 e aos 12 meses, com consequente melhoria das comorbilidades e da conseguinte qualidade de vida. Apesar disso, a perda de peso tende a estagnar ao fim de 1 a 2 anos. As principais carências nutricionais encontradas no pré-operatório foram o cálcio, o fósforo, o zinco e os folatos. As principais carências nutricionais encontradas após 6 meses da intervenção cirúrgica foram o zinco, os folatos e a hemoglobina. Ao fim de 12 e 24 meses após a cirurgia as principais carências foram zinco, ferro, folatos e hemoglobina. Em relação ao EDI, verificou-se que a partir aproximadamente do IMC de 30 até 55, o desejo de emagrecer é elevado e de algum modo aumenta à medida que aumenta aquele índice, contudo acima do IMC 60, surpreendentemente a maioria tem um desejo de emagrecer baixo.
Conclusões: A perda de peso acaba por estagnar ao fim de 1 a 2 anos após a intervenção cirúrgica, pelo que existe uma dificuldade em manter a perda de peso, acabando por recuperar parte do peso perdido. Quanto ao comportamento alimentar verificam-se melhorias em todas as subescalas do teste EDI entre a pré-cirurgia e após a cirurgia. Relativamente às carências nutricionais/bioquímicas conclui-se que o zinco, os folatos e a hemoglobina apresentam carência em todas as etapas desde a pré-cirurgia até aos 24 meses após a cirurgia, No processo em estudo, dos 147 doentes que iniciaram o processo, com o decorrer do tempo, um número significativo, negligencia os procedimentos formalmente definidos e recomendados para controlo do estado de saúde do doente.
Introduction: Bariatric surgery has been developed to be applied on weight loss in patients with morbid obesity in an attempt to reduce their comorbidities and increase their quality of life. However, there is evidence of potentially serious nutritional consequences regarding this type of surgery. Objective: The aim of this study is to verify if there is a significant weight loss in patients undergoing bariatric surgery, nutritional and biochemical deficiencies associated with this surgical intervention and analysis of dietary behaviors through EDI questionnaire before and after de surgery. Methods: A retrospective study was performed to identify the sociodemographic data (gender, age, profession), anthropometric data (weight, BMI), biochemical / nutritional data (iron, creatinine, ferritin, magnesium, potassium, sodium, phosphorus, calcium, folic acid, vitamin B12 , zinc, triglycerides, insulin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, uric acid, vitamin D), and prevalence of nutritional deficiencies and biochemical evaluation of feeding behavior (EDI test) in 147 patients of bariatric surgery between 2007 and 2010. The evaluations were made before the surgery and 6, 12, and 24 months after surgery. Data were analyzed by SPSS, in which, parametric tests (ANOVA - Repeated Measures) and nonparametric tests (Fisher test and Spearman´s) were applied. Results: After bariatric surgery, weight reduction is significant at 6 and 12 months, with consequent improvement in comorbidities and therefore quality of life. Nevertheless, the weight loss tends to stagnate between 1 and 2 years after the surgery. The main nutritional deficiencies found preoperatively were calcium, phosphorus, zinc and folate. The main nutritional deficiencies found at 6 months after surgery were zinc, folate and hemoglobin. At 12 and 24 months after surgery, the main problems were zinc, iron, folate and hemoglobin. Regarding the EDI, it was found that with the BMI between 30 to 55, a desire to lose weight is high and it rises with the increase of that index. However, patients with a BMI above 60, surprisingly show a lower desire to lose weight. Conclusions: The weight loss ultimately stagnate between 1 and 2 years after the surgery, so there is difficulty in maintaining weight loss and eventually recover some of the lost weight. As for the eating behavior are verified improvements in all subscales of the EDI test between pre-surgery and after surgery. Regarding nutritional / biochemical deficiencies is concluded that, zinc, hemoglobin and folates are below the desirable value in all stages from pre-surgery until 24 months after surgery. Throughout the study, a significant number of the 147 patients have neglected the formally define and recommended procedures for control of the patient health status.
Introduction: Bariatric surgery has been developed to be applied on weight loss in patients with morbid obesity in an attempt to reduce their comorbidities and increase their quality of life. However, there is evidence of potentially serious nutritional consequences regarding this type of surgery. Objective: The aim of this study is to verify if there is a significant weight loss in patients undergoing bariatric surgery, nutritional and biochemical deficiencies associated with this surgical intervention and analysis of dietary behaviors through EDI questionnaire before and after de surgery. Methods: A retrospective study was performed to identify the sociodemographic data (gender, age, profession), anthropometric data (weight, BMI), biochemical / nutritional data (iron, creatinine, ferritin, magnesium, potassium, sodium, phosphorus, calcium, folic acid, vitamin B12 , zinc, triglycerides, insulin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, uric acid, vitamin D), and prevalence of nutritional deficiencies and biochemical evaluation of feeding behavior (EDI test) in 147 patients of bariatric surgery between 2007 and 2010. The evaluations were made before the surgery and 6, 12, and 24 months after surgery. Data were analyzed by SPSS, in which, parametric tests (ANOVA - Repeated Measures) and nonparametric tests (Fisher test and Spearman´s) were applied. Results: After bariatric surgery, weight reduction is significant at 6 and 12 months, with consequent improvement in comorbidities and therefore quality of life. Nevertheless, the weight loss tends to stagnate between 1 and 2 years after the surgery. The main nutritional deficiencies found preoperatively were calcium, phosphorus, zinc and folate. The main nutritional deficiencies found at 6 months after surgery were zinc, folate and hemoglobin. At 12 and 24 months after surgery, the main problems were zinc, iron, folate and hemoglobin. Regarding the EDI, it was found that with the BMI between 30 to 55, a desire to lose weight is high and it rises with the increase of that index. However, patients with a BMI above 60, surprisingly show a lower desire to lose weight. Conclusions: The weight loss ultimately stagnate between 1 and 2 years after the surgery, so there is difficulty in maintaining weight loss and eventually recover some of the lost weight. As for the eating behavior are verified improvements in all subscales of the EDI test between pre-surgery and after surgery. Regarding nutritional / biochemical deficiencies is concluded that, zinc, hemoglobin and folates are below the desirable value in all stages from pre-surgery until 24 months after surgery. Throughout the study, a significant number of the 147 patients have neglected the formally define and recommended procedures for control of the patient health status.
Descrição
Tese de mestrado, Doenças Metabólicas e do Comportamento Alimentar, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Cirurgia bariátrica Obesidade mórbida Carências nutricionais Eating disorders inventory (EDI) Teses de mestrado - 2015