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Publications (24)77.17 Total impact

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    ABSTRACT: Bariatric surgery has been shown to be an effective treatment for obesity. Changes in energy expenditure, especially through diet-induced thermogenesis (DIT), have been identified as one of the mechanism to explain this success. However, not all patients are able to maintain a healthy postoperative weight loss. In this way, a question arises: in the weight regain after bariatric surgery, are these changes in energy metabolism still active?
    No preview · Article · Jan 2016 · Surgery for Obesity and Related Diseases
  • Silvia Faria · Orlando Faria · Mariane Cardeal · Marina Ito

    No preview · Article · Nov 2015 · Surgery for Obesity and Related Diseases

  • No preview · Article · Nov 2015 · Surgery for Obesity and Related Diseases
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    Silvia Leite Faria · Orlando Pereira Faria · Mariane de Almeida Cardeal
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    ABSTRACT: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88±17.50 months, and for the No-Ring Group 51±15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors that have definite influence in the health of the bariatric patient.
    Full-text · Article · Nov 2014 · Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
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    ABSTRACT: Background: Preoperative bariatric patients can follow very low calorie diets (VLCD), reducing surgical risks. However, possible advantages of a liquid diet over one of normal consistency are controversial. This study investigated the effect of a liquid VLCD compared with one of normal consistency considering visceral fat (VF) loss and metabolic profile in preoperative clinically severe obese patients. Methods: This was a randomized, open-labeled, controlled clinical trial. Patients were divided into 2 groups: liquid diet and normal diet. Data were collected at baseline and 7 and 14 days after intervention. Information gathered was analyzed for loss of weight and VF, biochemical data, anthropometric data, and energy intake. Results: Fifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet. The liquid diet group lost significantly more weight (P<.0290) and VF (P<.0410) than the normal diet group. An inverse correlation occurred between VF loss and surgical time among the liquid diet group (r2=-.1302, P=.001). Additionally, there was a positive correlation between the percentage of excess weight loss and ketonuria (P=.0070). No between-group difference occurred regarding calorie intake. Conclusion: Patients that consumed a liquid diet presented a positive effect on reducing VF and greater weight loss than the normal diet group. Both VLCDs presented benefits offering a protective effect during the preoperative stage.
    No preview · Article · Jul 2014 · Surgery for Obesity and Related Diseases
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    ABSTRACT: Body mass index (BMI) is the most common parameter for classifying nutritional status. However, body composition (BC) may vary considerably among individuals with identical BMIs; consequently, we need to assess BC efficiently. Bariatric surgery is the most effective method for treating obesity. To improve quality assessment of postoperative weight loss, it is essential to assess BC. Multi-frequency bioelectrical impedance analysis (BIA) is a practical assessment instrument, though limited when applied among the obese population. Despite dual-energy X-ray absorptiometry (DXA) being the current reference standard, it has physical limitations which restrict its practical application. This study, therefore, sought to correlate the results of BC assessments of same patient population using BIA and DXA. This was a cross-sectional validation study with patients invited to undergo a multi-frequency BIA (Inbody 720®) and afterwards a DXA examination Statistical analyses were done using the intraclass correlation coefficient (ICC), paired t-test and the Bland-Altman plot analysis. A total of 108 patients were randomly selected, with 73 meeting the criteria for study inclusion. Most were female (89 %) and had an average BMI of 40.17 ± 4.08 kg/m(2). An almost perfect correlation of fat (kg) and fat-free mass (kg) was found in results from the BIA and DXA examination (ICC = 0.832 and ICC = 0.899, respectively). A substantial correlation was also found between the percentage of body fat (%BF) and the percentage of fat-free mass (%FFM). The comparison made between the BIA and DXA using the t-test showed significant differences between all parameters. The Bland-Altman plot showed that the BIA method tends to underestimate the FM and overestimate the LM measurements when compared with DXA. BIA proved to be a safe alternative for assessing BC in clinically severely obese patients and thus provides a more accessible evaluation tool for this population. But, consideration should be given to the formula added to the BIA measurement, adjusting the values to differences observed in order to reduce errors when compared with the DXA measurements.
    No preview · Article · Jan 2014 · Obesity Surgery
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    ABSTRACT: The part nutrition plays is seen as a vital component for managing post-operative bariatric surgery patients. Nutritional therapy must encompass relevant aspects in weight loss, as well as contribute to maintaining long-term nutritional status. Nutritional care after bariatric surgery does have particular details employed to achieve certain goals. The assessment and monitoring of nutritional status in the postoperative period follows a routine which should occur in an individualized, and prophylactic way for maintaining the health of these patients. In the first postoperative month the use of a multiphase diet is encouraged by many surgical weight loss programs. The role of nutritional education in bariatric surgery continues through the following months as an instrument used to improve the surgical outcome, weight loss and the maintenance of weight loss in the long term. The assessment of weight loss must be carried out every month. In terms of excess weight loss, 70% is expected in the end of the first year. In addition to weight loss and the rate at which it occurs, the quality of weight loss must be monitored. One year after the surgery, patients may be close to a healthy weight. The rate of weight loss and/or weight stabilization has diminished. Two years after the surgery, some patients may present a small weight regain. Nutritional education and advice on how to cut and chew food, along with other eating behavior habits must be given to patients early in the preoperative period to avoid food intolerance. There is a tendency in looking for easy-to-swallow foods instead of protein foods. This may lead the patient to an extensive loss of lean mass and to nutritional deficiencies. Concerning protein consumption, related to bariatric surgery, a minimum of 60 grams per day is recommended. Also, Bariatric patients should consume a low glycemic load diet. Poly-vitamins and polyminerals are routinely prescribed due to three important factors: change in the absorption site, intake restriction and lesser contact of foods with digestive enzymes. Calcium supplementation must be carried out by the use of calcium citrate. Iron supplementation must be carried out in the form of iron with chelated amino acid or in the form of iron fumarate. Nutritional support is indispensable so that this tool may be used successfully, with the aim to achieve a healthy weight loss and maintenance.
    No preview · Article · Apr 2013
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    ABSTRACT: Bariatric surgery is the most effective treatment for morbid obesity, offering satisfactory long-term weight loss and maintenance. It is, however, a procedure susceptible to the development of nutritional deficiencies, i. e. anemia, due to low food intake, the effects of gastric restriction and malabsorption which occurs. Anemic etiology may be due to deficiencies of iron, folate and/or vitamin B12. The risk of iron deficiency anemia is increased after RYGB and may occur because of reduced intake of foods containing organic iron, a lower production of hydrochloric acid and/or the exclusion of the major sites of iron absorption: the duodenum and proximal jejunum. Diagnosis of anemia can be made using a complete blood count. Iron deficiency anemia (hypochromic and microcytic) is characterized by decreased serum ferritin levels (<20ng/ml),associated with increased iron binding capacity, a decrease in hemoglobin concentration and decreased mean corpuscular volume. It is recommended that bariatric patients make daily use of two multivitamins and multiminerals, thus providing for 200% RDA of iron, as a way of preventing iron deficiency anemia. In treating anemia, ferrous sulfate can be used at a dosage of 650mg/d. Thus, in some cases, serum ferritin may be elevated even with low serum iron, characterizing a condition known as anemia of chronic disease, a common framework related to obesity and early post-operative response to surgery. Deficiency of Vitamin B12 and folic acid can lead to the development of megaloblastic anemia (macrocytic). Bariatric patients should keep their B12 levels above 400ug/dl. With levels between 100 and 400, patients may have subclinical deficiency and supplementation is recommended. The diagnosis of folic acid deficiency can be done using homocysteine and erythrocyte folate tests. Supplementation which aims at preventing folate deficiency must reach 200% of DRIs. Orientation concerning nutritional deficiencies that may result from bariatric surgery are essential to the multidisciplinary team in the post-op phase, in order to maintain the good health and quality of life of patients.
    No preview · Article · Apr 2013
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    ABSTRACT: Computerized tomography is the gold-standard for measurement of abdominal visceral fat. However, it is costly and involves submitting patients to ionizing radiation. To validate the use of ultrasonography in assessing abdominal visceral fat among clinically serious obese patients of both genders. The sample included adult patients with clinically serious obesity with body mass index of 40kg/m2 or from 35kg/m2 to 40kg/m2 with co-morbidities. Abdominal visceral fat thickness was measured using ultrasound and tomography. Two ultrasonographic exams were conducted to assess the interobserver reproducibility among a patient subsample. Validation was done by comparing these results with the tomographic findings. The study included 13 patients (61.54% female) with an average BMI of 38.82 kg/m2. In terms of validation, the result obtained from applying the Pearson correlation coefficient was equal to 0.94 (p = 0.0005), showing a strong positive correlation between the two measurements. As for the results for reproducibility, the interobserver was equal to 0.822, with a confidence interval of 95% (-0.076 to 0.980), revealing good interobserver agreement. The average difference between the two ultrasound interobserver examination was equal to 0.10 ± 1.51 (p=0.8898) and so not significant. Interobserver bias was also not significant. The validation of ultrasonographic examination to replace tomographic method in assessing abdominal visceral fat among clinically serious obese patients was effective. The ultrasound measurement is independent of the examiner.
    Full-text · Article · Jan 2013 · Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
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    ABSTRACT: Background: Studies in humans and other animals have shown that Roux-en-Y gastric bypass (RYGB) leads to increased energy expenditure (EE). We analyzed several components of EE, such as the respiratory quotient (RQ), resting metabolic rate (RMR), and diet-induced thermogenesis (DIT) among patients before and after RYGB. Methods: In this prospective clinical study, RMR, DIT, and RQ were measured by indirect calorimetry (IC) in the same patients before and 12 months after RYGB (the preoperative and postoperative time points, respectively). Postprandial RQ and DIT were measured after patients consumed a standard ~270 kcal meal (62% carbohydrates, 12% proteins, and 26% lipids). Results: The population studied consisted of 13 patients (mean age 40.8 ± 6.7 years, 85% female).At the postoperative (postop) time point, patients showed higher weight-adjusted RMR compared with the preoperative (preop) time point (P<.01). The absolute and weight-adjusted metabolic rates 20 minutes after the meal were increased postoperatively (P<.0001) but not preoperatively (P = 0.2962) (DIT); this increase in RQ was significantly higher in the postop than in the preop time point. Conclusion: The observed patients showed increased EE, DIT, and RQ after RYGB surgery. These data may serve as important physiologic factors contributing to the loss and maintenance of weight after RYGB.
    Full-text · Article · Jul 2012 · Surgery for Obesity and Related Diseases
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    ABSTRACT: Weight loss may decrease the energy expenditure (EE) because of changes in body composition (BC). The reduction in EE may contribute, in part, to weight regain. Experimental studies in animals indicate that Roux-en-Y Gastric Bypass (RYGB) increases the resting metabolic rate (RMR) when adjusted for body weight (BW). Thus, the aim of this study was to assess the clinical effects of RYGB on EE in patients who have undergone RYGB. The study was prospective and included 46 RYGB patients whose RMR was assessed prior to and at least 6 months post-surgery by indirect calorimetry. BW and BC were measured at these same time points using bioelectric impedance. RMR was adjusted for changes in BW, i.e., kilocalories per kilogram. Statistical tests were used to analyze the results. The BW-adjusted RMR (kilocalories per kilogram) increased post-RYGB by 17.66 % (p < 0.0001). RMR adjusted for BW was negatively correlated to the total percentage of body fat preoperatively (r = -0.30729, p = 0.0378) and postoperatively (r = -0.46731, p = 0.0011) and was positively correlated to the fat-free mass percentage (%FFM) both preoperatively and postoperatively. Furthermore, BW-adjusted RMR and %FFM were positively correlated to percent excess weight loss (r = 0.55398, p < 0.0001 and r = 0.31677, p = 0.0283, respectively). Weight loss following RYGB is associated with an increase in BW-adjusted RMR and with %FFM. An increase in energy expenditure post-RYGB may be responsible, in part, for successful long-term weight loss of the RYGB procedure.
    No preview · Article · May 2012 · Obesity Surgery
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    ABSTRACT: Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p < 0.0001). A positive correlation between fat-free mass and a negative correlation between body fat percentage and BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.
    No preview · Article · Apr 2012 · Obesity Surgery
  • S. Faria · O. P. Faria

    No preview · Conference Paper · Aug 2011

  • No preview · Conference Paper · Aug 2011

  • No preview · Conference Paper · Aug 2011
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    ABSTRACT: Bariatric surgery, a highly successful treatment for obesity, requires adherence to special dietary recommendations to insure the achievement of weight loss goals and weight maintenance. Postoperative consumption of protein is linked to satiety induction, nutritional status, and weight loss. Hence, we conducted an extensive literature review to identify studies focused on the following: protein and nutritional status; recommendations for dietary protein intake; the effects of protein-rich diets; and associations between dietary protein intake and satiety, weight loss, and body composition. We found that there have been few studies on protein intake recommendations for bariatric patients. Dietary protein ingestion among this population tends to be inadequate, potentially leading to a loss of lean body mass, reduced metabolic rates, and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhanced weight loss, and improved body composition. The quality and composition of protein sources are also very important, particularly with respect to the quantity of leucine, which helps to maintain muscle mass, and thus is particularly important for this patient group. Randomized studies among bariatric surgery patient populations are necessary to establish the exact quantity of protein that should be prescribed to maintain their nutritional status.
    Full-text · Article · May 2011 · Obesity Surgery

  • No preview · Conference Paper · Aug 2010
  • Silvia Faria · Orlando P. Faria · Rafael Galvao · Margaret Furtado

    No preview · Conference Paper · Aug 2010

  • No preview · Article · May 2010 · Surgery for Obesity and Related Diseases

  • No preview · Article · May 2010 · Surgery for Obesity and Related Diseases