-
Manuel Ruz,
Fernando Carrasco,
Pamela Rojas,
Juana Codoceo,
Jorge Inostroza, Annabella Rebolledo,
Karen Basfi-fer,
Attila Csendes,
Karin Papapietro,
Fernando Pizarro,
Manuel Olivares,
Lei Sian,
Jamie L Westcott,
K Michael Hambidge,
Nancy F Krebs
[show abstract]
[hide abstract]
ABSTRACT: Iron deficiency and iron deficiency anemia are common in patients who undergo gastric bypass. The magnitude of change in iron absorption is not well known.
The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on iron status and iron absorption at different stages after surgery. We hypothesized that iron absorption would be markedly impaired immediately after surgery and would not improve after such a procedure.
Anthropometric, body-composition, dietary, hematologic, and iron-absorption measures were determined in 67 severe and morbidly obese women [mean age: 36.9 +/- 9.8 y; weight: 115.1 +/- 15.6 kg, body mass index (BMI: in kg/m(2)); 45.2 +/- 4.7] who underwent RYGBP. The Roux-en-Y loop length was 125-150 cm. Determinations were carried out before and 6, 12, and 18 mo after surgery. Fifty-one individuals completed all 4 evaluations.
The hemoglobin concentration decreased significantly throughout the study (repeated-measures analysis of variance). The percentage of anemic subjects changed from 1.5% at the beginning of the study to 38.8% at 18 mo. The proportion of patients with low serum ferritin increased from 7.5% to 37.3%. The prevalence of iron deficiency anemia was 23.9% at the end of the experimental period. Iron absorption from both a standard diet and from a standard dose of ferrous ascorbate decreased significantly after 6 mo of RYGBP to 32.7% and 40.3% of their initial values, respectively. No further significant modifications were noted.
Iron absorption is markedly reduced after RYGBP with no further modifications, at least until 18 mo after surgery.
American Journal of Clinical Nutrition 08/2009; 90(3):527-32. · 6.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass. The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass. In forty-four women with severe and morbid obesity it was assessed their nutrient intakes before and 6, 12, and 18 months after gastric bypass by using three-day food records. Vitamin and mineral intakes from supplements were strictly controlled though personalized records. With the exceptions of calcium and vitamin A, energy and nutrient intakes were significantly decreased at 6, 12, and 18 month after bypass compared to the pre-surgery period. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from the 6th month after the surgery and thereafter. This situation is reverted when nutrient intakes supplied by supplements are taken into account. Although a "U" shape trend was observed in the nutrient intakes results during the experimental period, in most cases the differences between the observed values at month 12 and 18 were not significant. In conclusion, these patients had important reductions of their energy and nutrient intakes as result of gastric bypass. Routine supplements may correct this situation, nevertheless, the anatomical alterations inherent to this type of surgery may cause that total nutrient intakes reaching adequacy values slightly above 100%, may not necessarily be able to avoid the development of nutritional deficiencies.
Archivos latinoamericanos de nutrición 04/2009; 59(1):7-13. · 0.23 Impact Factor
-
Fernando Carrasco,
Manuel Ruz,
Pamela Rojas,
Attila Csendes, Annabella Rebolledo,
Juana Codoceo,
Jorge Inostroza,
Karen Basfi-Fer,
Karin Papapietro,
Jorge Rojas,
Fernando Pizarro,
Manuel Olivares
[show abstract]
[hide abstract]
ABSTRACT: Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted.
Forty-two women (BMI 45.0 +/- 4.3 kg/m(2); 37.7 +/- 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA.
Twelve months after, GBP weight was decreased by 34.4 +/- 6.5% and excess weight loss was 68.2 +/- 12.8%. Significant reduction (p < 0.001) in total BMD (-3.0 +/- 2.1%), spine BMD (-7.4 +/- 6.8%) and hip BMD (-10.5 +/- 5.6%) were observed. Adiponectin concentration increased from 11.4 +/- 0.7 mg/L before surgery to 15.7 +/- 0.7 and 19.8 +/- 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r (2) = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36).
GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.
Obesity Surgery 08/2008; 19(1):41-6. · 3.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to compare changes of nutrient intakes and nutritional status of selected minerals, during a three-month weightloss program using diets with distinct energy contents. 62 obese women (age 33.2 +/- 8.3 years; BMI 34.6 +/- 3.4 kg/m2) were allocated to two diets, one supplying 1000 kcal/d (Diet 1), and the other 1300 kcal/d (Diet 2). Before and after 3 months, intakes of iron (Fe), zinc (Zn), copper (Cu), and calcium (Ca) were evaluated through self-reported three-day dietary records. Selected laboratory parameters related to the nutritional status of iron, zinc and copper were analyzed: hemoglobin, serum ferritin, zinc-protoporfirin, transferrin saturation, plasma zinc, hair zinc, and plasma copper. Mean weight loss was 10.8% on Diet 1 and 8.5% on Diet 2 (p = 0.29). Intakes of Fe, Zn, Cu and Ca decresed by 50%, 30%, 40%, and 9%, respectively. The change of serum ferritin was significantly greater in the group on Diet 1 (p = 0.04), in > or =10% of weight loss subjects (p = 0.006) and in patients with lower protein intake (p = 0.033). Others parameters studied, although tended consistently to present greater disturbances in subjects receiving the 1000 kcal/d diet, they did not reach statistical significance. The prescription of weight-reducing diets with 1000 y 1300 kcal/d did not produce major effects on the nutritional status of minerals during the first three months of treatment, except by the significant detriment of body iron stores in subjects receiving the 1000 kcal diet, as indicated by the changes of serum ferritin.
Archivos latinoamericanos de nutrición 09/2007; 57(3):238-47. · 0.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass.
The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y.
The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively.
Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.
Nutrition 04/2007; 23(3):277-80. · 3.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The prevalence of obesity is growing in Chile. The personal perception about the own nutritional status is associated to the risk of obesity.
To analyze the personal perception about their nutritional status among adults living in Santiago and to compare it to the objective diagnosis obtained according to Chilean Health Ministry norms. MATERIAL AND METhODS: The body image was explored in 735 people between the ages of 20 and 90. The weight and height were obtained under standard conditions, and the body mass index (BMI) was calculated (kg/m2) and classified according to the criteria of the Health Ministry. The concordance and Kappa index between both criteria in function of age, gender, nutritional status and height were analyzed. The model that best explained the weight subestimation was determined with multivariate logistic regressions.
Fifty two percent of subjects classified correctly their nutritional status, 30% subestimated, and 18% overstimated the nutritional status (Kappa 0.27). The multivariate analysis showed greater subestimation in obese (OR 5.8 95% IC 4.2- 7.9), in men (OR 4.5 95% IC 2.7-7.3), people younger than 60 years old (OR 2.0 95% IC 1.3-3.1) and people of small stature (OR 3.1 95% IC 1.9-4.9).
Half of the studied subjects had an inadequate perception of the body image. Educative campaigns are needed to reinforce the concept of adequate weight. This may contribute to promote health and reduce the risk of obesity.
Revista medica de Chile 12/2004; 132(11):1383-8. · 0.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to compare the fractional zinc absorption (FAZ) and the size of the rapidly exchangeable zinc pool (EZP) after three months of iron supplementation in women consuming ferrous sulfate between meals. Twenty-one non-anemic apparently healthy women received on average 55.1 +/- 18.5 mg elemental iron per day as ferrous sulfate, and five received no supplemental iron. Fractional absorption of zinc was determined before and three days after finishing the third month of iron supplementation by using an extrinsic labeling with zinc stable isotopes and a dual isotope enrichment method in urine. EZP was determined from urine enrichment following intravenous administration of 70Zn. Results of selected zinc-related variables in the iron supplemented women were (before vs. after iron supplementation): FAZ with meal 0.22 vs. 0.24, p = .23; FAZ in fasting state 0.58 vs. 0.69, p = .005; EZP 177 mg vs. 160 mg, p = .058; plasma zinc 90.6 vs. 86.1 micrograms/dl, p = .065. The control group remained unchanged. The capacity to absorb zinc was increased three days after terminating a period of iron supplementation as compared with the pre-iron period. This may be attributable to impairment of zinc status by the iron supplements as evidenced by a trend for lower plasma zinc and EZP.
Food and nutrition bulletin 10/2002; 23(3 Suppl):209-12. · 1.92 Impact Factor
