REGANHO DE PESO E PERFIL METABÓLICO DE MULHERES NO PÓS-OPERATÓRIO DE CIRURGIA BARIÁTRICA: ANÁLISE MULTIARIADA

Santos, Andréia Lira; Silva, Silvia Alves da; Cavalcante-E-Silva, Larissa Maria; Leão, Luís Henrique de Albuquerque; Coutinho, Lucas Ribeiro; Oliveira, Fernando de Santa Cruz; Ferraz, Álvaro Antonio Bandeira

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 36 • 2023 • https://doi.org/10.1590/0102-672020230037e1755 copiar

REGANHO DE PESO E PERFIL METABÓLICO DE MULHERES NO PÓS-OPERATÓRIO DE CIRURGIA BARIÁTRICA: ANÁLISE MULTIARIADA

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

RACIONAL:

Reganho de peso no pós-operatório de cirurgia bariátrica está diretamente relacionado à recidiva das comorbidades pré-operatórias e a um impacto negativo no perfil bioquímico desses pacientes.

OBJETIVOS:

avaliar o impacto metabólico do reganho de peso nas comorbidades pré-operatórias e no perfil bioquímico desses pacientes, a fim de mostrar o impacto das complicações nos desfechos metabólicos finais da cirurgia bariátrica.

MÉTODOS:

Estudo retrospectivo que analisou 75 mulheres no pós-operatório tardio de cirurgia bariátrica que apresentaram reganho patológico de peso (=20% do máximo de peso perdido). Foram coletados dados referentes às medidas dos perfis glicêmico, lipídico e inflamatório em três momentos distintos de avaliação: no pré-operatório, no nadir de peso (menor peso) e após o reganho ponderal. Foi realizada uma análise multivariada.

RESULTADOS:

A idade média foi 46.39±12.09 anos. IMC médio pré-operatório foi 40.10±4.11 kg/m². Houve um aumento de 3,36 pontos no IMC médio entre o nadir e após reganho: de 26.30±3.9 Kg/m² para 29.66±4.66 Kg/m². O tempo médio para atingir o nadir foi de 18±7.6 meses, com uma %PEP de 91.08±11.8%. O tempo médio para o reganho patológico foi de 48 meses, e a média de reganho foi 8.85±5.65 kg. Houve correlação significativa entre o reganho patológico e os níveis de insulina (r=0.351; p<0.011), peptídeo C (r=0.303; p<0.011), proteína C reativa (r=0.402; p<0.001) e vitamina D (r=-0.435; p<0.001), sendo os dois últimos os mais influenciados pela porcentagem de reganho de peso.

CONCLUSÕES:

O reganho de peso patológico no pós-operatório de cirurgia bariátrica resulta em prejuízos ao perfil metabólico e inflamatório dos pacientes. No entanto, os benefícios bioquímicos perduram em relação aos níveis pré-operatórios dos parâmetros analisados

DESCRITORES:
Cirurgia bariátrica; Obesidade; Alterações do peso corporal

Weight Regain
	<20%			≥20%
	n	%	95%CI	n	%	95%CI	p-value
Glucose							0.712^╬ ╬ Fisher’s exact test.
Normal	22	34.4	22.9–47.3	42	65.6	52.7–77.1
High	4	44.4	13.7–78.8	5	55.6	21.2–86.3
HbA1c							0.202^ Pearson’s χ² test with Yates correction; ┼χ² test for trend;
Normal	21	42	28.2–56.8	29	58	43.2–71.8
High	6	24	9.4–45.1	19	76	54.9–90.6
Insulin							1,000^╬ ╬ Fisher’s exact test.
Normal	24	35.3	24.1–47.8	44	64.7	52.2–75.9
High	0	0	0.00–97.5	1	100	100–100
C-peptide							0.171^ Pearson’s χ² test with Yates correction; ┼χ² test for trend;
Low	9	47.4	24.4–71.1	10	52.6	28.9–75.6
Normal	15	29.4	17.5–43.8	36	70.6	56.2–82.5
CRP							0.001^ Pearson’s χ² test with Yates correction; ┼χ² test for trend;
Normal	21	52.5	36.1–68.5	19	47.5	31.5–63.9
High	3	10.7	2.3–28.2	25	89.3	71.8–97.7
Total Cholesterol							0.744^* * Pearson’s χ² test;
Normal	13	34.2	19.6–51.4	25	65.8	48.6–80.4
High	14	37.8	22.5–55.2	23	62.2	44.8–77.5
HDL							0.648^╬ ╬ Fisher’s exact test.
Normal	26	37.1	25.9–49.5	44	62.9	50.5–74.1
Low	1	20	0.5–71.6	4	80	28.4–99.5
LDL							0.635^* * Pearson’s χ² test;
Desirable	12	38.7	21.8–57.8	19	61.3	42.2–78.2
High	14	33.3	19.6–49.5	28	66.7	50.5–80.4
Triglycerides							0.195^╬ ╬ Fisher’s exact test.
Normal	25	40.3	28.1–53.6	37	59.7	46.4–71.9
High	2	18.2	2.3–51.8	9	81.8	48.2–97.7
Iron							0.737^╬ ╬ Fisher’s exact test.
Normal	23	36.5	24.7–49.6	40	63.5	50.4–75.3
Low	3	27.3	6.0–61.0	8	72.7	39.0–94.0
Ferritin							0.028^ Pearson’s χ² test with Yates correction; ┼χ² test for trend;
Normal	10	62.5	35.4–84.8	6	37.5	15.2–64.6
Low	17	28.8	17.8–42.1	42	71.2	57.9–82.2
Zinc							0.300^╬ ╬ Fisher’s exact test.
Normal	18	32.1	20.3–46.0	38	67.9	54.0–79.7
Low	5	50	18.7–81.3	5	50	18.7–81.3
Albumin							0.537^╬ ╬ Fisher’s exact test.
Normal	25	36.2	25.0–48.7	44	63.8	51.3–75.0
Low	0	0	0.00–84.2	2	100	100–100
Vitamin D							0.020^ Pearson’s χ² test with Yates correction; ┼χ² test for trend;
Desirable	12	57.1	34.0–78.2	9	42.9	21.8–66.0
Low	7	21.9	09.3–40.0	25	78.1	60.0–90.7

	Preoperative		Nadir		Regain
	Median	P25–P75	Median	P25–P75	Median	P25–P75
Glucose	94.00^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	86.0–104.0	82.00	78.0–86.2	85.00^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	81.0–90.0
HbA1c	5.70^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	5.4–6.1	5.40	5.0–5.6	5.50^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	5.1–5.8
Insulin	20.00^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	13.0–30.0	5.00	3.0–8.0	7.00^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	5.0–11.0
C-peptide	3.14^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	2.2–4.2	1.60	1.2–2.2	1.80^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	1.4–2.6
CRP	1.47^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	0.6–5.8	0.86	0.2–1.7	0.50	0.1–2.5
Total Cholesterol	202.0^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	175–225	179	156–216	190.0^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	158–215
HDL	47.00^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	39.0–53.6	57	48.0–63.0	55.1	48.0–65.0
VLDL	26.00*	24.4–36.0	17.2	13.0–137	16.20	13.4–25.1
LDL	123.40*	99.2–142.0	108	79.4–137	109.3	79.7–136
Triglycerides	138.00*	113–192	82.00	62.0–121	78.00	55.5–127
Iron	82.00*	57.0–96.0	92.5	69.2–110	88.5	61.0–114
Ferritin	85.00	46.3–138.0	73	30.8–155	30.00^┼ ┼ Statistical significance at 5% in the comparison between the nadir and regain weight	10.2–77.0
Zinc	81.10	70.2–89.1	82.95	62.5–90.5	89.15	75.0–92.8
Albumin	4.10	4.0–4.4	4.22	4.0–4.5	4.30	4.1–4.5
Vitamin D	23.70^* * Statistical significance at 5% in the comparison between preoperative and the nadir weight;	19.0–33.2	28.8	14.2–34.2	27.10	21.1–34.4

Weight Regain (kg)
	r	R²	p-value
Glucose	-0.006	0.000	0.959^ Spearman correlation test.
HbA1c	0.066	0.004	0.574^ Spearman correlation test.
Insulin	0.351	0.123	0.003^ Spearman correlation test.
C-peptide	0.303	0.092	0.011^* * Pearson correlation rest;
CRP	0.402	0.162	0.001^ Spearman correlation test.
Total Cholesterol	0.115	0.013	0.325^* * Pearson correlation rest;
HDL	-0.106	0.011	0.368^* * Pearson correlation rest;
VLDL	0.193	0.037	0.155^* * Pearson correlation rest;
LDL	0.140	0.020	0.237^* * Pearson correlation rest;
Triglycerides	0.130	0.017	0.274^ Spearman correlation test.
Iron	-0.100	0.010	0.396^* * Pearson correlation rest;
Ferritin	0.015	0.000	0.897^ Spearman correlation test.
Zinc	0.061	0.004	0.628^ Spearman correlation test.
Albumin	-0.088	0.008	0.464^ Spearman correlation test.
Vitamin D	-0.435	0.189	0.001^* * Pearson correlation rest;
Postoperative Time (months)	0.458	0.2098	0.000
Weight gain (kg)	0.458	0.2098	0.000

Postoperative time (months)
	r	R²	p–value
Glucose	0.040	0.0016	0.736^ Spearman correlation test.
HbA1c	0.182	0.0331	0.117^ Spearman correlation test.
Insulin	0.051	0.0026	0.680^ Spearman correlation test.
C-peptide	0.109	0.0119	0.370^* * Pearson correlation test;
CRP	0.153	0.0234	0.213^ Spearman correlation test.
Total Cholesterol	-0.035	0.0012	0.766^* * Pearson correlation test;
HDL	0.010	0.0001	0.934^* * Pearson correlation test;
VLDL	0.001	0.0000	0.996^* * Pearson correlation test;
LDL	-0.038	0.0014	0.751^* * Pearson correlation test;
Triglycerides	-0.037	0.0014	0.754^ Spearman correlation test.
Iron	-0.182	0.0331	0.120^* * Pearson correlation test;
Ferritin	-0.050	0.0025	0.672^ Spearman correlation test.
Zinc	0.193	0.0372	0.120^ Spearman correlation test.
Albumin	-0.215	0.0462	0.072^ Spearman correlation test.
Vitamin D	-0.488	0.2381	0.000^* * Pearson correlation test;
Weight gain (kg)	0.458	0.2098	0.000

	Raw analysis		Adjusted analysis			Raw analysis		Adjusted analysis*
	PR	95%CI	PR	95%CI	p^ Poisson regression with robust variance adjustment.	PR	95%CI	PR	95%CI	p--^ Poisson regression with robust variance adjustment.
CRP
Normal	1.00		1.00		0.005	1.00		1.00
High	1.34	1.17–1.54	1.35	1.16–1.57	0.000	1.28	1.14-1.45	1.30	1.16–1.47	0.000
Vitamin D
Desirable	1.00	1.04–1.45	1.00			1.00		1.00
Low	1.17		1.26	1.07–1.48	0.005	1.25	1.05-1.56	1.33	1.16–1.52	0.000

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[1] Correspondence: Fernando Santa-Cruz. E-mail: f.santacruzoliveira@gmail.com