Η βαριατρική χειρουργική είναι η μόνη διαδικασία που μπορεί να εφαρμοσθεί προκειμένου να επιτευχθεί μόνιμη απώλεια βάρους στην πλειονότητα των ασθενών με υπερ-νοσογόνο παχυσαρκία (130). Οι βαριατρικές χειρουργικές επεμβάσεις ορίζονται ως περιοριστικές, δυσαπορροφητικές ή περιοριστικές και δυσαπορροφητικές ταυτόχρονα. Οι περιοριστικού τύπου χειρουργικές επεμβάσεις έχουν συνδεθεί με αυξημένα ποσοστά αποτυχίας όσον αφορά στην απώλεια βάρους στους υπερ-παχύσαρκους ασθενείς, με αποτέλεσμα να παρατηρείται προοδευτική αύξηση της εφαρμογής βαριατρικών εγχειρήσεων δυσαπορροφητικού τύπου σε όλο τον κόσμο για αυτήν την υπο-ομάδα παχυσαρκίας (100, 108, 130, 131). Παρά την απώλεια βάρους που μπορεί να επιτευχθεί με αυτές τις χειρουργικές επεμβάσεις, οι μετεγχειρητικές ανεπάρκειες σε πρωτεΐνη, σίδηρο, βιταμίνες, άλατα και λιποδιαλυτές βιταμίνες αποτελούν σύνηθες φαινόμενο και απαιτούν χορήγηση συμπληρωμάτων προκειμένου να διατηρηθούν σε φυσιολογικά επίπεδα. Οι ανεπάρκειες αυτές οφείλονται στη δυσαπορρόφηση που προκύπτει από τη χειρουργική παράκαμψη τμημάτων του γαστρεντερικού σωλήνα, όπου τα διάφορα διατροφικά συστατικά απορροφούνται (118). Αν και αναμενόμενες, οι μεταβολικές ανωμαλίες πολύ συχνά δε διαγιγνώσκονται ή υποεκτιμούνται. Τα βιβλιογραφικά δεδομένα που αναφέρονται στις διατροφικές ανεπάρκειες που παρατηρούνται μετά τις βαριατρικές εγχειρήσεις είναι περιορισμένα, και απαρτίζονται από αναφορές σε μεμονωμένα περιστατικά ασθενών (124-126), από επισκοπήσεις αποτελεσμάτων παλαιότερων ερευνών (118, 132) και από περιστασιακές προοπτικές μελέτες (118, 131). Αν και υπάρχουν αρκετές πληροφορίες για διατροφικά συστατικά, όπως είναι η πρωτεϊνη, ο σίδηρος, η βιταμίνη Β12, το φυλλικό οξύ και το ασβέστιο (118, 131), τα στοιχεία που παρατίθενται για τις λιποδιαλυτές βιταμίνες είναι ελάχιστα και ελλιπή. Αυτό οφείλεται σε σημαντικό βαθμό στη δυσκολία απομόνωσης και προσδιορισμού των λιποδιαλυτών βιταμινών από τον ορό του αίματος, διαδικασία αρκετά επίπονη, δαπανηρή και χρονοβόρα. Οι περισσότεροι χειρούργοι προσπαθούν να ελέγξουν με έμμεσο τρόπο τα επίπεδα των λιποδιαλυτών βιταμινών, όπως για παράδειγμα με παρακολούθηση των τιμών της PTH, άνοδος της οποίας συνηγορεί σε πιθανή ελάττωση των επιπέδων της βιταμίνης D3 (133), ή με παρακολούθηση του χρόνου προθρομβίνης των ασθενών ανά τακτά χρονικά διαστήματα, αύξηση του οποίου μπορεί να υποδεικνύει την ελάττωση των επιπέδων της βιταμίνης Κ (134). Στις περισσότερες περιπτώσεις, η ανεπάρκεια των λιποδιαλυτών βιταμινών γίνεται αντιληπτή μόνο από τις κλινικές της εκδηλώσεις ( 124, 125, 135). Σκοπός αυτής της εργασίας ήταν η προεγχειρητική εκτίμηση των επιπέδων λιποδιαλυτών βιταμινών στο αίμα υπερ-παχύσαρκων ασθενών που υποβλήθηκαν σε δυσαπορροφητική επέμβαση κατά Roux-en-Y γαστρικής παράκαμψης με χολοπαγκρεατική εκτροπή, καθώς και η μετεγχειρητική παρακολούθησή τους για ένα έτος, ώστε να καταστεί δυνατή η άμεση εκτίμηση της κατάστασης των ασθενών ως προς τα αποθέματα βιταμίνης A, D E και Κ και να διερευνηθεί κατά πόσο η χειρουργικά προκαλούμενη δυσαπορρόφηση λίπους επηρεάζει την απορρόφησή και τα επίπεδα των λιποδιαλυτών βιταμινών στο αίμα. / Background: Bariatric surgery seems to be the only effective approach for the long-term management of morbid obesity. Weight loss after Roux-en-Y Gastric Bypass with Biliopancreatic Diversion (RYGBP/BPD) is mainly due to decreased calorie absorption secondary to fat malabsorption. Fat malabsorption may also cause essential fat-soluble vitamin deficiencies which may become clinically significant if not recognized and properly treated. Prevention of these vitamin deficiencies includes both supplementation and routine measuring of serum values. In this work, an investigation was undertaken to examine preoperative and short-term (1 year) postoperative levels of fat-soluble vitamins in patients undergoing RYGBP/BPD. Methods: Study population consisted of 15 super-obese (BMI>50kg/m2) patients who had undergone RYGBP/BPD. Routine postoperative daily supplementation consisted of 4000 IU (1200 μg) vitamin A, 2000 IU (50 μg) vitamin D3, 10 mg vitamin E and 2000 mg calcium. Preoperative and postoperative serum levels of fat-soluble vitamins A, D3, 25(OH)D3, E, K2, were measured in these patients by HPLC. Results: All vitamin levels tended to decrease with time after RYGBP/BPD operation despite that all patients were taking daily multivitamin supplements p.o. postoperatively. One year after the bariatric operation, a significant decrease (P<0.05) in D3, 25(OH)D3, E and K2 levels was observed compared to the preoperative levels. This decrease led to vitamin deficiency one year after the operation, the incidence of which was 7,7% for vitamin A, 41.7% for vitamin 25(OH) D3 and 27.3% for K2. Concerning vitamin E, all patients had lower than normal levels even before operation and the deficiency insisted even after operation, despite the administration of vitamin supplements to the patients. The low preoperative serum vitamin E levels in the patients confirmed that obese individuals are at high risk of vitamin E deficiency. Conclusions: The serum levels of fat-soluble vitamins A, D, E and K decreased with time following RYGBP/BPD operation in morbidly obese patients, despite that the patients received vitamin supplements postoperatively. The results of our study indicate that patients undergoing the RYGBP/BPD operation need long-term postoperative monitoring of serum fat-soluble vitamin levels. This will facilitate the administration of appropriate doses of multivitamin supplements to these patients, preventing vitamin deficiency to become of clinical significance.

Background: In morbidly obese individuals (MO) cardiorespiratory comorbidities and body habitus challenge the perioperative management of anesthesia. To implement safe and reproducible routines for anesthesia and fluid therapy is the cornerstone in order to minimize anesthesia-related complications and to meet individual variability in rehydration needs. Methods: Paper I: Impact of rapid-weight-loss preparation prior to bariatric surgery was investigated. Prevalence of preoperative dehydration and cardiac function were assessed with transthoracic echocardiography (TTE). Paper II: The anesthetic technique for rapid sequence induction (RSI) in MO based on a combination of volatile and i.v. anesthetics was developed. Pre- and post-induction oxygenation, blood pressure levels and feasibility of the method was evaluated. Paper III: The preoperative ideal body weight based rehydration regime was evaluated by TTE. Paper IV: Need of rehydration during bariatric surgery was evaluated by comparing conventional monitoring to a more advanced approach (i.e. preoperative TTE and arterial pulse wave analysis). Results: Rapid-weight-loss preparation prior to bariatric surgery may expose MO to dehydration. TTE was shown to be a robust modality for preoperative screening of the level of venous return, assessment of filling pressures and biventricular function of the heart in MO. The combination of sevoflurane, propofol, alfentanil and suxamethonium was demonstrated to be a safe method for RSI regardless of BMI. The preoperative rehydration regime implemented by colloids 6 ml/kg IBW was an adequate treatment to obtain euvolemia. In addition, preoperative rehydration seems to increase hemodynamic stability during intravenous induction of anesthesia and even intraoperatively. Conclusion: This thesis describes a safe and comprehensive perioperative management of morbidly obese individuals scheduled for bariatric surgery. Hemodynamic and respiratory stability can be achieved by implementation of strict and proven methods of anesthesia and fluid therapy. Much focus should be placed on feasible monitoring and preoperative optimization in morbidly obese individuals for increased perioperative safety.

Šiuo metu Pasaulyje skrandžio apjuosimo reguliuojama juosta operacijos sudaro apie 43 % visų chirurginių operacijų, atliekamų nutukimui gydyti. Iki šiol nėra pilnai ištirta operacijoje naudojamų skrandį apjuosiančių reguliuojamų juostų konstrukcijos skirtumų įtaka gydymo rezultatams, taip pat nėra priimtų pacientų atrankos šiai operacijai kriterijų. Disertacijoje palyginome vienerių metų nutukimo chirurginio gydymo rezultatus naudojant skirtingas skrandį apjuosiančias reguliuojamas juostas – SAGB ir MiniMizer Extra. Nustatėme, kad skrandžio apjuosimo reguliuojama juosta operacija yra efektyvus ir saugus nutukimo gydymo būdas: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 33,1 ± 21,9%; vertinant pagal BAROS, 34.1% pacientų pasiekė patenkinamą, 30,6% - gerą, 9,4% – labai gerą ir 2,4% – puikų gydymo rezultatą; pasitaikė 5 (4,9%) „didžiosios” komplikacijos. Esminių skirtumų tarp lygintų juostų efektyvumo ir komplikacijų skaičiaus po vienerių metų po operacijos nenustatyta: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas SAGB ir MiniMizer Extra grupėse buvo atitinkamai 28,9 ± 21,3% ir 36,8 ± 22.1%, p=0.075, o „didžiųjų” komplikacijų skaičius atitinkamai 0 (0%) ir 5 (9.3%), p=0.069. 40 metų ir vyresni pacientai geresnių rezultatų pasiekė naudojant MiniMizer Extra juostą - vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 37,5 ± 20,8% prieš 23,6 ± 13,8 % SAGB grupėje, p=0.002. Pacientai, kurių pradinis KMI ≤ 47, geresnių... [toliau žr. visą tekstą] / It has been estimated that LAGB represents about 42% of bariatric operations performed worldwide. There are a number of different adjustable gastric bands available. Few attempts have been made to compare the influence of band design differences for efficiency and complication rate. There are no accepted criteria for choosing this particular operation. In the dissertation we compared one year results after adjustable gastric banding using different adjustable gastric bands – SAGB and MiniMizer Extra. We have determined that laparoscopic adjustable gastric banding is effective and safe bariatric procedure: the average percentage of initial excess body mass index loss was 33,1 ± 21,9%; 34.1% of patients achieved fair, 30,6% - good, 9,4% - very good and 2,4% - excellent results according to BAROS; only 5 (4,9%) major complications were diagnosed. No radical differences were stated between the efficiency and complication rate of the compared adjustable gastric bands: the average percentage of initial excess body mass index loss in SAGB and MiniMizer Extra groups was 28,9 ± 21,3% and 36,8 ± 22.1% respectively, p=0.075; major complication rate was 0 (0%) and 5 (9.3%) respectively, p=0.069. Patients at the age of 40 and older achieved better results using MiniMizer Extra band - the average percentage of initial excess body mass index loss was 37,5 ± 20,8% versus 23,6 ± 13,8% in SAGB group, p=0.002. Patients with initial BMI ≤ 47 achieved better results using MiniMizer Extra band... [to full text]

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Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-25Bitstream added on 2014-06-13T19:29:46Z : No. of bitstreams: 1 novais_pfs_me_arafcf.pdf: 4697762 bytes, checksum: 72f6ec5a19cce394ae3c3d7d11b28b1b (MD5) / Unimep / Constitui consenso que a cirurgia bariátrica atualmente configura o único tratamento para alcançar perda de peso significativa e durável em obesos mórbidos. Avaliar não apenas a perda de peso e melhora de comorbidezes, mas variáveis relacionadas à qualidade de vida e aspectos alimentares torna-se essencial no processo de acompanhamento após a cirurgia, pois no pós-cirúrgico, principalmente em longo prazo, ainda restam muitas indagações. O objetivo do presente do trabalho foi avaliar a evolução do peso corporal e a sua relação com o consumo alimentar e a qualidade de vida de mulheres com mais de dois anos da cirurgia bariátrica. O estudo contou com a participação de 141 mulheres; com idade média de 44±9 anos; submetidas ao procedimento cirúrgico de Derivação Gástrica em Y de Roux no Centro de Gastroenterologia e Cirurgia da Obesidade – Clínica Bariátrica, vinculado ao Hospital Fornecedores de Cana de Piracicaba/SP. Para efeito de análise, as participantes do presente estudo foram divididas e analisadas em três grupos de acordo com a percentagem de perda do excesso de peso (%PEP): < 50%; 50 ┤75%; ≥ 75%. De acordo com o %PEP, observou-se que após seis meses de cirurgia, as mulheres apresentaram %PEP de 55%, após um ano 70,6%, após dois anos 74%, após três anos 70,2%, após quatro anos 67,5%, após cinco anos 67,8%, após seis anos 69,7% e após sete anos 70,1%. Em relação aos dados antropométricos históricos, notou-se diferença em todos os grupos, as mulheres do grupo com %PEP < 50% se mantiveram obesas em relação à classificação do IMC, naquelas que apresentaram %PEP superior a 75%, a faixa de variação situou-se entre a eutrofia e sobrepeso. Já a perda de peso total em quilos entre os grupos foi estatisticamente significativa entre o peso da cirurgia e o peso aos seis meses de pós-operatório, depois disso as diferenças não se confirmaram... / There is consensus that bariatric surgery is currently the only treatment capable of achieving significant and long-lasting weight loss in morbidly obese individuals. It is essential to assess not only the weight loss and improvement of comorbidities, but also variables related to quality of life and food intake during the postoperative follow-up since there are still many unanswered questions regarding the postoperative period, especially the late postoperative period. The objective of this study was to assess body weight changes over time and their relationship with food intake and quality of life of women two or more years after bariatric surgery. A total of 141 women with a mean age of 44±9 years subjected to Roux-en-Y gastric bypass at the Gastroenterology and Obesity Surgery Center – Bariatric Clinic of the Hospital Fornecedores de Cana in Piracicaba/SP participated in this study. They were divided into three groups according to the percentage of excess weight loss (EWL): ≤ 50%; 50 ┤75%; ≥ 75%. Percentage of EWL over time was as follows: 55% at six months, 70.6% at one year, 74% at two years, 70.2% at three years, 67.5% at four years, 67.8% at five years, 69.7% at six years, and 70.1% at seven years. The anthropometric data over time differed in all groups: women in the %EWL≤50% group continued to be classified as obese according to their BMI; those in the %EWL≥75% group were no longer classified as obese but as normal or overweight. Meanwhile, the amount of weight loss in the first six months after surgery was statistically significant for all groups. After 6 months the weight stabilizes as no more statistically significant weight loss is achieved. When the women were grouped according to years after surgery to analyze weight changes over time, a significant weight loss occurred between six months and one year after surgery. There was no significant weight regain when... (Complete abstract click electronic access below)

Submitted by MARCELO DE JESUS MARTINS null (celoufba@yahoo.com.br) on 2018-01-05T11:45:24Z No. of bitstreams: 1 Marcelo Martins (Tese de Doutorado).pdf: 3508982 bytes, checksum: ff73bd80060bf710ecc113d389df649e (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-01-05T17:19:45Z (GMT) No. of bitstreams: 1 martins_mj_dr_bot.pdf: 3508982 bytes, checksum: ff73bd80060bf710ecc113d389df649e (MD5) / Made available in DSpace on 2018-01-05T17:19:45Z (GMT). No. of bitstreams: 1 martins_mj_dr_bot.pdf: 3508982 bytes, checksum: ff73bd80060bf710ecc113d389df649e (MD5) Previous issue date: 2017-12-11 / Justificativa: a obesidade é uma doença crônica caracterizada por acúmulo excessivo de gordura corporal. Devido aos riscos associados, é considerada um grande problema de saúde pública nos países desenvolvidos. A cirurgia bariátrica (gastroplastia aberta) tem sido usada como uma estratégia importante para tratar esta condição nos países em desenvolvimento, especialmente quando associada a outras comorbidades. A qualidade de recuperação, no entanto, tem sido uma preocupação frequente no manejo pós-operatório desses pacientes. A pregabalina é um análogo estrutural do neurotransmissor ácido gama-aminobutírico (GABA) que se liga à subunidade alfa-2 do canal de cálcio voltagem dependente, bloqueando o desenvolvimento da hiperalgesia e a sensibilização central à dor. Objetivo: o objetivo principal da pesquisa foi avaliar o efeito da pregabalina perioperatória versus placebo na qualidade de recuperação pós-operatória em pacientes submetidos à cirurgia bariátrica. Métodos: trata-se de estudo prospectivo, randomizado, controlado com placebo, duplo cego. Após a aprovação do Comitê de Ética, setenta pacientes submetidos à gastroplastia abdominal foram randomizados para receber pregabalina, grupo 1 (75 mg por via oral 1 hora antes da cirurgia) ou uma pílula de placebo idêntica, grupo 2. O desfecho primário foi a avaliação da qualidade da recuperação (questionário QoR-40) em 24 horas. Os resultados secundários incluíram o consumo de opioides e os escores de dor pós-operatória. Um valor de P <0,05 foi usado para rejeitar erro de tipo I. Resultados: foram randomizados setenta pacientes e 60 indivíduos completaram o estudo. A mediana dos escores globais de recuperação (qualidade de recuperação QoR-40) às 24 horas após a cirurgia no grupo de pregabalina foi de 185 (176-191) x 184 (174-192) no grupo placebo (P = 0,95). O consumo total de opioides nas 24 horas não apresentou diferença estatisticamente significativa entre os grupos. Além disso, a incidência de náusea, o vômitos e o tempo de alta da unidade de cuidados pós-anestésicos não foram significativamente reduzidos no grupo pregabalina em comparação com o placebo. Conclusões: o uso pré-operatório de pregabalina não resulta em melhora na qualidade da recuperação pós-operatória, redução dos escores de dor, bem como redução do consumo de opioides em pacientes submetidos à cirurgia bariátrica. / Background: obesity is a chronic disease characterized by excessive accumulation of body fat. Due to the associated risks, it has been considered a major public health problem in developed countries. Bariatric surgery (open gastroplasty) has been used as an important strategy to treat this condition in developing countries, especially when associated with other comorbidities. The quality of recovery, however, has been a frequent concern in the postoperative management of these patients. Pregabalin is a structural analogue of the gamma-aminobutyric acid neurotransmitter (GABA) that binds to the alpha-2-subunit of the voltage-dependent calcium channel, blocking the development of hyperalgesia and central pain sensitization. Objective: the main objective of the current investigation was to evaluate the effect of perioperative pregabalin versus placebo on postoperative quality of recovery in patients undergoing bariatric surgery. Methods: the study was a prospective, randomized, placebo-controlled, double-blinded trial. After ethics committee approval, seventy patients undergoing abdominal gastroplasty were randomized to receive pregabalin, group 1 (75 mg orally 1 hour before surgery) or an identical placebo pill, group 2. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results: seventy patients were randomized and 60 subjects completed the study. The median in global recovery scores (quality of recovery-40) at 24 hours after surgery in pregabalin group was 185 (176-191) x 184 (174-192) in placebo group (P = 0.95). Total opioid consumption in the 24 hours did not present a statistically significant difference between the groups. In addition, nausea, vomiting, and time to post-anesthesia care unit discharge were not significantly reduced in the pregabalin group compared with placebo. Conclusions: preoperative use of pregabalin showed no improve in quality of postoperative recovery, no better pain relief as well as reduction of opioid consumption in patients submitted to bariatric surgery.

Orientador: Norma Sueli Pinheiro Módolo / Resumo: Justificativa: a obesidade é uma doença crônica caracterizada por acúmulo excessivo de gordura corporal. Devido aos riscos associados, é considerada um grande problema de saúde pública nos países desenvolvidos. A cirurgia bariátrica (gastroplastia aberta) tem sido usada como uma estratégia importante para tratar esta condição nos países em desenvolvimento, especialmente quando associada a outras comorbidades. A qualidade de recuperação, no entanto, tem sido uma preocupação frequente no manejo pós-operatório desses pacientes. A pregabalina é um análogo estrutural do neurotransmissor ácido gama-aminobutírico (GABA) que se liga à subunidade alfa-2 do canal de cálcio voltagem dependente, bloqueando o desenvolvimento da hiperalgesia e a sensibilização central à dor. Objetivo: o objetivo principal da pesquisa foi avaliar o efeito da pregabalina perioperatória versus placebo na qualidade de recuperação pós-operatória em pacientes submetidos à cirurgia bariátrica. Métodos: trata-se de estudo prospectivo, randomizado, controlado com placebo, duplo cego. Após a aprovação do Comitê de Ética, setenta pacientes submetidos à gastroplastia abdominal foram randomizados para receber pregabalina, grupo 1 (75 mg por via oral 1 hora antes da cirurgia) ou uma pílula de placebo idêntica, grupo 2. O desfecho primário foi a avaliação da qualidade da recuperação (questionário QoR-40) em 24 horas. Os resultados secundários incluíram o consumo de opioides e os escores de dor pós-operatória. Um valor de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: obesity is a chronic disease characterized by excessive accumulation of body fat. Due to the associated risks, it has been considered a major public health problem in developed countries. Bariatric surgery (open gastroplasty) has been used as an important strategy to treat this condition in developing countries, especially when associated with other comorbidities. The quality of recovery, however, has been a frequent concern in the postoperative management of these patients. Pregabalin is a structural analogue of the gamma-aminobutyric acid neurotransmitter (GABA) that binds to the alpha-2-subunit of the voltage-dependent calcium channel, blocking the development of hyperalgesia and central pain sensitization. Objective: the main objective of the current investigation was to evaluate the effect of perioperative pregabalin versus placebo on postoperative quality of recovery in patients undergoing bariatric surgery. Methods: the study was a prospective, randomized, placebo-controlled, double-blinded trial. After ethics committee approval, seventy patients undergoing abdominal gastroplasty were randomized to receive pregabalin, group 1 (75 mg orally 1 hour before surgery) or an identical placebo pill, group 2. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results: seventy patients were randomized and 60 subjects comple... (Complete abstract click electronic access below) / Doutor

Orientador: Silvia Cristina Mangini Bocchi / Resumo: A obesidade é classificada pelo índice de massa corporal (IMC) superior a 30,00kg/m2, doença caracterizada pelo excesso de gordura, cuja prevalência está associada ao aumento do risco de doença crônica, podendo resultar em mortalidade precoce. Fatores genéticos, endócrinos, neurológicos, psicológicos e ambientais podem estar relacionados à doença. Com o avanço tecnológico na saúde, a procura pelo tratamento cirúrgico aumentou. Infelizmente, a maioria dos indivíduos considera a cirurgia como ponto final, mas é apenas uma ferramenta para controlar a doença, pois a mesma pode acarretar intercorrências associadas às adaptações do organismo como o reganho de peso e em alguns casos reaparecimento das comorbidades. Assim, questiona-se porque alguns indivíduos reganham peso e apresentam dificuldade de adaptação à nova condição e quais são os fatores que interferem nesse processo. O objetivo do presente estudo foi avaliar indivíduos submetidos à cirurgia bariátrica e verificar se há relação entre condição psicológica e evolução dos indicadores bioquímicos e nutricionais durante dois anos pós-cirúrgico. Além disso, buscamos identificar quais indicadores são mais evidentes, quando ocorre o reganho de peso e qual o momento de maior risco na ocorrência do mesmo e a relação entre percepção do suporte familiar e sobrecarga do cuidado com o reganho de peso. Trata-se de um estudo longitudinal prospectivo, caracterizado por coorte única seguida por 2 anos, cuja amostragem foi por conveniência.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Obesity is classified by a body mass index (BMI) of more than 30.00 kg/m2, a disease characterized by excess fat whose prevalence is associated with an increased risk of chronic disease and may cause early mortality. Genetic, endocrine, neurological, psychological and environmental factors may be related to the disease. With the technological advancement in health, the demand for surgical treatment has increased, however, most patients consider surgery as an end point, but it is only a tool to control the disease, since it can lead to complications associated with the body's adaptations such as weight regain. In some cases reappearance of comorbidities. Thus, it is questioned why some individuals regain weight and have difficulty in adapting to the new condition and what the factors that interfere in the process are. The objective of the study was to evaluate individuals submitted to bariatric surgery, whether there is any relation between psychological condition and evolution of biochemical and nutritional indicators, during 2 years post-surgery. As well as, identify which indicators are more evident, when the weight regain occurs, what is the moment of greatest risk of this occurring, and the relation between perception of the family support and overload of care with weight regain. It is a longitudinal prospective study, characterized by a single cohort followed for 2 years, whose sampling was for convenience. After signing the TCLE, it was started the biochemical, nutritio... (Complete abstract click electronic access below) / Doutor

Orientador: Maria Rita Marques de Oliveira / Resumo: Objetivo: O presente estudo teve como objetivo avaliar a concordância entre um equipamento de bioimpedância multifrequencial tetrapolar segmentar direta (DSM-BIA) e a água duplamente marcada (ADM) como método de referência na predição da composição corporal de mulheres submetidas à cirurgia bariátrica. Materiais e Métodos: Participaram do estudo 20 mulheres obesas mórbidas (idade: 29,3±5,1 anos; índice de massa corporal: 44,8±2,4 kg/m²) submetidas a cirurgia de derivação gástrica em Y-de-Roux. A composição corporal (massa de gordura [MG], massa livre de gordura [MLG] e água corporal total [ACT]) foi avaliada pelo equipamento InBody 230 e ADM nos períodos: pré, 6 e 12 meses após cirurgia. A acurácia entre os métodos foi avaliada pelo viés e pela raiz do erro quadrático médio enquanto a concordância entre os métodos foi avaliada pelo coeficiente de correlação de concordância (CCC) e método Bland Altman. A correlação de Pearson foi calculada para avaliar a correlação entre os métodos. Resultados: Foi observada correlação significativa (p<0,001) e boa/excelente CCC entre ambos métodos para avaliação da MG (r=0,84-0,92 CCC=0,84-0,95) MGL (r=0,73-0,90 e CCC=0,68-0,80) e ACT (r=0,76-0,91 e CCC=0,72-0,81) nos períodos pré e pós-cirurgia. Em adição, não foi observado viés significativo entre BIA e ADM para MG (erro médio [EM] = -1,40-0,60 kg), MLG (EM= 0,91-1,86 kg) e ACT (EM= 0,71-1,24 kg). Conclusão: A BIA, nas condições deste estudo, foi capaz de estimar a composição corporal de mu... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: Antonio Carlos Caramori / Resumo: A obesidade representa um dos maiores problemas de saúde pública no mundo e cursa com inúmeras complicações e comorbidades. As medidas de mudanças no estilo de vida, embora sejam as terapias mais duradouras, não têm conseguido resolver muitos casos, principalmente em pacientes com obesidade mórbida, onde a cirurgia bariátrica passa a ser uma opção no tratamento capaz de impedir a progressão de comorbidades. A DHGNA, uma das complicações da obesidade, tornou-se também preocupante, pois tem alta prevalência, potencial de progressão para doença hepática grave e associação com diabetes mellitus tipo 2 (DM2), síndrome metabólica e doença cardíaca coronariana. O acompanhamento multiprofissional, principalmente nutricional, no pré e pós-operatório pode positivamente interferir sobre a ocorrência da DHGNA e suas complicações. O presente estudo avaliou a influência do acompanhamento com equipe multiprofissional sobre a evolução da DHGNA, com dados coletados dos prontuários de 76 pacientes do Ambulatório de Obesidade Mórbida do Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB). A DHGNA foi observada por ecografia e biópsia hepática (em graus variados) nos pacientes submetidos à cirurgia bariátrica, cuja intensidade e frequência tiveram melhora no pós-operatório. Qualitativamente os registros da equipe demonstraram um atendimento humanizado que busca estratégias de aconselhamento, auxiliando o paciente nas mudanças do estilo de vida, porém, a atuação da mesma no serviço... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Obesity represents one of the major public health issues in the world and has a wide range of complications and comorbidities. The measures of lifestyle changes, even though they are the most long-lasting therapies, have not been able to solve many cases, mainly in patients with morbid obesity, where bariatric surgery becomes an option in the treatment able to prevent the progression of comorbidities. NAFLD, one of the complications of obesity, has also become a concern, as it has a high prevalence, a potential for progression to severe liver disease and association with type 2 diabetes mellitus (DM2), metabolic syndrome, and coronary heart disease. The multi-professional, mainly nutritional monitoring, both in the pre-and postoperative periods can positively interfere with the occurrence of NAFLD and its complications. The present study evaluated the influence of follow-up with the multi-professional team on the evolution of NAFLD, with data collected from the medical reports of 76 patients from the Morbid Obesity Outpatient Clinic of the Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB). NAFLD was observed by echography and liver biopsy (to varying degrees) in patients undergoing bariatric surgery, whose intensity and frequency had improvement in the postoperative period. Qualitatively, the team records have shown a humanized service which seeks counseling strategies, assisting the patient in lifestyle changes. However, its performance in the studied servic... (Complete abstract click electronic access below) / Mestre