RESUMO
BACKGROUND: We hypothesize that non-alcoholic fatty liver disease (NAFLD) may be significantly associated with waist circumference (WC), neck circumference (NC), hip circumference (HC), and waist-to-hip ratio (WHR). OBJECTIVES: To analyze correlations between anthropometric parameters and the occurrence and intensity of NAFLD aspects assessed by histopathological examination in individuals undergoing bariatric surgery. METHODS: This is a cross-sectional study carried out in a tertiary university hospital. Demographic, clinical, anthropometric, laboratory, and histopathological variables were analyzed; uni- and multivariate analyses were performed. Histopathological variables analyzed were findings of liver biopsies collected during surgical procedures. RESULTS: Of 119 individuals, 105 (88.2%) were female. The mean age was 38.8 ± 9.3 years and the mean BMI was 37.6 ± 3.1 kg/m2. The prevalence of NAFLD histopathological aspects was: steatosis (76.5%), steatohepatitis (49.6%), and fibrosis (51.3%). WC was significantly higher in individuals with steatosis (103.5 ± 9.9 vs. 99.4 ± 8.4; p = 0.03). Individuals with steatohepatitis presented significantly higher BMI (38.2 ± 3.2 vs. 36.7 ± 2.8; p = 0.01), WC (105.3 ± 10.4 vs. 99.6 ± 8.8; p = 0.002), and WHR (1 ± 0.1 vs. 0.9 ± 0.1; p = 0.02). Age (40.6 ± 9.7 vs. 37 ± 8.5; p = 0.03) and hemoglobin A1c (6.5 ± 0.5 vs. 5.6 ± 0.5; p = 0.004) were significantly higher among individuals with fibrosis. A positive correlation was observed between the steatosis intensity and WHR (R = 0.2; p = 0.04). BMI (R = 0.2; p = 0.02) and glucose (R = 0.2; p = 0.009) were independently correlated with the steatohepatitis intensity. Age (R = 0.3; p = 0.04) was independently correlated with the fibrosis intensity. CONCLUSION: There were significant associations between anthropometric parameters and NAFLD aspects. WC and WHR were associated with steatosis; BMI, WC, and WHR were associated with steatohepatitis. WHR independently correlated with steatosis intensity.
Assuntos
Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade , Obesidade Mórbida/cirurgiaAssuntos
Cirurgia Bariátrica , Neoplasias , Obesidade Mórbida , Gastrectomia , Humanos , Obesidade Mórbida/cirurgiaRESUMO
Argentina was able to anticipate public health interventions in order to flatten the contagion curve of CoViD-19. Eighty-three surgeons answered an online survey to assess the impact of the pandemic on bariatric surgery (BS) in Argentina. Most of them showed a high economic dependence on BS. Near 90% of health institutions were on phase 0 or I. While 90% still performed other laparoscopic surgeries, BS was suspended. In many surgeries for nonsuspected CoViD-19 patients, high personnel protection resources were applied. Ninety-five percent offered virtual consults. Most surgeons would not change usual algorithms or techniques. To restart BS a scientific society recommendation was expected, including patient selection criteria. The opinions gathered by this survey were taken into account to elaborate official recommendations for restarting elective BS.
Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , COVID-19/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Argentina/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Pandemias , Seleção de Pacientes , Inquéritos e Questionários , Telemedicina/estatística & dados numéricosRESUMO
BACKGROUND: Slight to moderate hepatic iron overload (HIO) can be found in cases of liver disease, including non-alcoholic fatty liver disease (NAFLD), but the mechanism is not completely understood, as well as its relationship with obesity. OBJECTIVE: To determine the prevalence of HIO assessed through histopathological examination in obese individuals undergoing bariatric surgery and to identify correlations between this condition and demographic, anthropometric, clinical, laboratory, and NAFLD-related aspects. METHODS: This is a cross-sectional study which enrolled individuals undergoing bariatric surgery from January 2018 to February 2019 at a tertiary university hospital. NAFLD and HIO were assessed through histological examination. RESULTS: Of 125 individuals, 87.2% were female and the average age was 38.8 ± 9.2 years. The average BMI was 37.2 ± 3.1 kg/m2. NAFLD was present in 66.4% and HIO in 17.6%, with 63.6% of patients with overload classified as mild (grade I) and 22.7% moderate (grade II). HIO was significantly more frequent in males (p = 0.003) and was significantly associated with higher levels of glucose (92.1 ± 28.4 vs. 80.7 ± 39.6; p = 0.02), ferritin (385.5 ± 290.9 vs. 131.6 ± 99.7; p < 0.0001), serum iron (82.4 ± 35.7 vs. 66.6 ± 25.1; p = 0.03), glutamic-oxaloacetic transaminase (27.3 ± 19.5 vs. 20.6 ± 8.8; p = 0.02), and glutamic-pyruvic transaminase (37.6 ± 36.4 vs. 24.6 ± 16.3; p = 0.01). Multivariate analysis showed that HIO intensity was significant and independently associated with ferritin levels (R = 0.19; p = 0.01), serum iron (R = 0.25; p < 0.0001), blood glucose (R = 0.16; p = 0.001), and total cholesterol (R = - 0.17; p < 0.0001). CONCLUSION: In obese individuals, HIO presented a high prevalence and was associated with higher levels of ferritin, serum iron, glucose, and transaminases; lower levels of total cholesterol; and male gender.
Assuntos
Cirurgia Bariátrica , Resistência à Insulina , Sobrecarga de Ferro , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Adulto , Estudos Transversais , Feminino , Humanos , Sobrecarga de Ferro/epidemiologia , Fígado , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , PrevalênciaRESUMO
PURPOSE: Obesity affects approximately 45-55% of persons with schizophrenia and is more difficult to manage in these individuals than in the general population, apart from being an additional factor for morbidity and premature mortality. Although bariatric surgery is considered the most effective long-term treatment for severe obesity, there are few reports on the outcomes of this procedure in persons with schizophrenia. This study aimed to evaluate weight loss and psychiatric symptoms in persons with obesity and schizophrenia after bariatric surgery. MATERIALS AND METHODS: Five persons with schizophrenia and moderate to severe obesity who underwent bariatric surgery were followed up for 2 years. Anthropometric data were collected, and psychiatric symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), which assessed the pre- and postoperative occurrence and severity of symptoms of schizophrenia. RESULTS: The mean body mass index before surgery was 43.5 ± 5.2 kg/m2 and decreased to 28.1 ± 1.9 kg/m2 1 year postoperatively. The mean percentage of total postoperative weight loss was 30.7 ± 6.8% after 6 months, 34.7 ± 7.9% after 1 year, and 34.3 ± 5.5% after 2 years. Before surgery, all subjects were in remission based on the PANSS. Postoperative evaluations showed that the participants had no relapse of psychiatric symptoms (p > 0.05 for the three PANSS dimensions throughout the follow-up period). There were no considerable changes in their medication regimens. CONCLUSIONS: These findings suggest that bariatric surgery may be a viable treatment option for stable patients with schizophrenia if they have a preoperative assessment and close management and involvement by mental health professionals throughout the course of treatment.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Obesidade Mórbida , Esquizofrenia , Índice de Massa Corporal , Humanos , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). METHODS: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. RESULTS: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). CONCLUSION: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.