Aspectos nutricionais no período pós-operatório tardio de bypass gástrico em Y-de-Roux

Abstract

Introduction: The anatomophysiological changes of the digestive tract inherent to Roux-en-Y gastric bypass (RYGB) are associated with compromised nutritional status, including protein malnutrition. In addition, regaining excess body weight has been shown in the postoperative period of RYGB. Objectives: To describe the clinical evolution of four patients submitted to RYGB who presented severe protein malnutrition in the postoperative period. It was also the objective of the study to analyze the evolution of body weight and foods habits of men and women obese and 10 years post-RYGB. Material and methods: Article 1: Case report of four patients submitted to RYGB, followed at Clinical Hospital of Uberlandia, Federal University of Uberlandia (CHU-FUU), period 2007-2019. Article 2: Cross-sectional observational study of 47 patients undergoing RYGB (1999-2007) and 32 obese controls evaluated at the CHU-FUU outpatient clinic. Were included patients (or responsible) who signed the informed consent form and participated in outpatient care with completion of food frequency questionnaire and assessment of nutritional status. Data collection was performed using a semi-structured specific form, and the postoperative clinical and laboratory evolution was recorded, including anthropometric data. Results: Article 1: The four patients reported had severe protein malnutrition in the post-RYGB period. During evolution were recorded, diarrheal stools, steatorrhea; anemia; edema, anasarch; severe asthenia; difficulty walking; amenorrhea and alopecia. Laboratory tests identified hypoalbuminemia (e.g. 2.0 g/dL) and anemia (e.g. 5.0 g/dL). Individualized dietary guidelines were performed during periodic outpatient follow-up. In specific clinical situations, the consumption of a specialized oral diet rich in complex carbohydrates and soluble fibers, restricted in fats, insoluble fibers, lactose, sugars and sweets was oriented; supplemented with polymeric diet, multivitamin and specific nutrients. When necessary, the patients were hospitalized, received specialized diets, blood transfusion and / or albumin replacement. Due to severe protein malnutrition, two patients died and one patient underwent partial reversal of RYGB. Article 2: The preoperative body mass index (BMI) was 51.4 ± 7.4 kg/m² and the post-RYGB period was 14.8 ± 1.2 years. Post-RYGB women had lower mean lower-BMI-post-RYGB than post-RYGB men (p = 0.006). Post-RYGB women had lower mean overweight loss at post-RYGB weight than men post-RYGB (p = 0.003). Post-RYGB men had higher frequency of consumption for fatty foods (regular consumption of ultra-processed / fried foods, > 2 servings / day of meat / eggs, preference for meat with apparent fat) and consumption of sugars / sweets. Post-RYGB women had a preference for removing apparent fat from meat; and higher dairy consumption (3 servings / day) than pre-RYGB women (p = 0.028), but showed a preference for the integral type. Post-RYGB women had excessive sugar / candy intake, more frequently than pre-RYGB women (p = 0.04). Conclusions: Due to the severe consequences of protein malnutrition for the clinical evolution of post-RYGB patients, including death cases, nutritional deficiencies require early diagnosis and treatment. Consumption of not recommended amounts of fatty foods, sugars and sweets predisposes men and women undergoing RYGB to overweight regain. Therefore, criterious surgical indication and follow-up by a multidisciplinary team of post-BGYR patients are essential for health promotion.