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Name: KYMBERLE BETZEL KOEHLER NASCIMENTO
Publication date: 23/05/2018
Advisor:
Name |
Role |
|---|---|
| FABIANO KENJI HARAGUCHI | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| FABIANO KENJI HARAGUCHI | Advisor * |
| LUCIANE BRESCIANI SALAROLI | Internal Examiner * |
| ROGERIO GRACA PEDROSA | Co advisor * |
| VALERIO GARRONE BARAUNA | External Examiner * |
Summary: Introduction: Bariatric surgery is indicated as a treatment for severe obesity, and nutritional assessment in the first six months after surgery is imperative, given the acute weight loss that can occur in this period. Phase angle (PA) is indicated as an indicator of nutritional status and prognosis, and inflammatory and nutritional prognostic indexes have been used to evaluate patients in several clinical situations. The relationship between PA and inflammatory and nutritional prognostic indexes is poorly understood, especially in bariatric patients. The aim of this study was to evaluate PA and its correlation with inflammatory and nutritional prognostic indexes in women submitted to Roux-en-Y gastric by-pass (RYGB). Methods: The study was performed with female patients of the Bariatric Surgery Program of the Cassiano Antonio Moraes University Hospital. The patients were evaluated in three moments: approximately one month before surgery (M0), and approximately two (M1) and sixth (M2) months after surgery. The following parameters were evaluated: body weight, height, body mass index (BMI), PA, serum concentrations of prealbumin, albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (α1-AG), the CRP/Albumin Ratio and the Prognostic Inflammatory and Nutritional Index (PINI). Data were analyzed using the Shapiro-Wilk Normality Test, one-way ANOVA test for repeated measurements with Sidak post hoc, and Pearson or Spearman correlations, depending on the nature of the data. Results: Body weight and BMI decreased significantly over the evaluated periods (P <0.05). The PA had a significant reduction over the evaluated periods, with values in M1 and M2 differing from M0. Serum concentrations of pre-albumin, CRP and α1-AG were significantly reduced over time, with concentrations in M1 and M2 differing from M0 (P <0.05). The CRP/albumin ratio showed a significant reduction over time, with M1 and M2 being different from M0 (P <0.05). The PINI did not show statistically significant alterations, but indicated a change in the classification of low risk of complications for no infection / inflammation, demonstrating an improvement in the prognosis of these patients. There was a very strong correlation between PINI and the CRP/albumin ratio (r = 0.96, P <0.001). There was no significant correlation between PA and prognostic indexes, however, a direct strong correlation between PA and pre-albumin serum concentrations (r = 0.63, P <0.01) was observed, which remained moderate in M0 ( r = 0.55, P = 0.01) and M1 (r = 0.57, P <0.01), suggesting the use of AF as an indicator of nutritional status during the perioperative period of women submitted to RYGB. Conclusion: PA decreased and inflammatory and nutritional prognosis improved. PA did not correlate with improvement in the prognosis indicated by the indexes, however, the strong correlation between PA and pre-albumin serum concentrations suggests its applicability in the evaluation of nutritional risk after RYGB and reinforces its use as an alternative tool to evaluate the nutritional status.
Keywords: Obesity. Gastric Bypass. Eletric Impedance. Biomarkers.
