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Class III Obesity and its Relationship with the Nutritional Status of Vitamin A in Pre- and Postoperative Gastric Bypass

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Abstract

Background

Epidemiological findings have shown the rise of the prevalence of obesity in several segments of the world population, and more recent evidences point to a possible association with vitamin A deficiency (VAD). The aim of this study was to investigate vitamin A nutritional status in individuals with class III obesity in the preoperative period and 30 and 180 days after Roux-en-Y gastric bypass, correlating these findings with lipid profile and body mass index (BMI).

Methods

The sample was composed of class III obese individuals, males and females, in the preoperative period (T1) and 30 (T2) and 180 days (T3) after bariatric surgery with 5,000 IU of supplementation of retinol acetate. Vitamin A nutritional status was assessed through biochemical indicators (retinol and β-carotene serum levels), which were quantified by high-performance liquid chromatography with an inadequacy cutoff of <1.05 μmol/L and ≥40 μg/dL, respectively.

Results

Out of the 114 assessed patients, the mean age was 36.9 ± 11.6 years and BMI was ≥40 kg/m2. The prevalence of VAD was 14%, being 37.5% in T1, 50.8% and 67.8% in T2, and 52.9% and 67% in T3, according to retinol and serum β-carotene, respectively. A decrease of retinol and β-carotene serum levels was observed with BMI increase in T1. An increase of very-low-density lipoprotein cholesterol (VLDLc) and triglycerides was verified with the increase of retinol, being VLDLc in T3 and triglycerides in T1 and T2. In T1, high-dense lipoprotein cholesterol presented a positive and significant correlation with β-carotene and a negative and significant correlation in T3.

Conclusion

High prevalence of VAD in the preoperative period and in 30 and 180 postoperative days, even during supplementation, with higher inadequacy of β-carotene in all the three studied time periods, probably occurred because of its bioconversion to retinol due to the increased demand to which those individuals were exposed. It is suggested that the oral intake supplementation does not present the expected impact, and the need of assessing the nutritional status of vitamin A in the pre- and postoperative Roux-en-Y gastric bypass is emphasized. High prevalence of VAD in T1, with severity in T2 and T3, corroborates the utilization of the cutoff of <1.05 μmol/L as a VAD marker in the studied segment and reinforces its utilization as a tool in clinical practice to identify VAD in morbid obese patients who underwent bariatric surgery.

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References

  1. Halpen A. Fisiologia da Obesidade (Physiology of Obesity). In: Garrido Júnior AB, Ferraz EM, Barroso FL, et al., editors. Cirurgia da obesidade (Obesity Surgery). São Paulo: Atheneu; 2003. p. 9–12.

    Google Scholar 

  2. Bender R, Zeeb H, et al. Causes of death in obesity: relevant increase in cardiovascular but not in all-cancer mortality. J Clin Epidemiol. 2006;59:1064–71.

    Article  Google Scholar 

  3. Fundação Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2002–2003: Análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil (Research of family budgets: 2002–2003: Analysis of home availability of foods and of the nutritional status in Brazil). Rio de Janeiro: Ministério do Planejamento e Orçamento/IBGE; 2004.

    Google Scholar 

  4. Freedman DS, Khan LK, Serdula MK, et al. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;188:1758–61.

    Article  Google Scholar 

  5. Coutinho WF, Benchimol AK. Obesidade mórbida e afecções associadas (Morbid obesity and associated infections). In: Garrrido-Júnior AB, Ferraz EM, Barroso FL, et al., editors. Cirurgia da obesidade (Obesity Surgery). São Paulo: Ed Atheneu; 2003. p. 13–7.

    Google Scholar 

  6. Bloomberg RD, Fleishman A, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;2:145–54.

    Article  Google Scholar 

  7. Brolin RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg. 1999;2:150–4.

    Article  Google Scholar 

  8. Malinowski SS. Nutrition and metabolic complications of bariatric surgery. Am J Med Sci. 2006;4:219–25.

    Article  Google Scholar 

  9. Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;1:48–55.

    Article  Google Scholar 

  10. Horner MR, Dorea JG, Pereira MG, et al. Inquérito dietético com base no consumo familiar: o caso de Ilhéus, Bahia, Brasil, em 1979 (Dietary inquiry with basis on family consumption: the case of Ilhéus, Bahia, Brazil, in 1979). Arch Latinoam Nutr. 1981;31:726–39.

    CAS  PubMed  Google Scholar 

  11. Santos LMP, Asciutti LS, Dricot DC. Exophthalmia in the state of Paraíba, northeast of Brazil clinical findings. Am J Clin Nutr. 1983;38:139–44.

    Article  CAS  Google Scholar 

  12. United Nations Children’s Fund. Vitamin A and mineral deficiency: a global assessment. New York; 2004.

  13. Institute of Medicine. Vitamin A. In: Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press; 2001. p. 82–161.

    Google Scholar 

  14. Singh RB, Niaz MA, Bishnoi I, et al. Diet, antioxidant vitamins, oxidative stress and risk of coronary artery disease: the Peerzada prospective study. Int J Cardiol. 1994;5:453–67.

    Google Scholar 

  15. Mosca L, Rubenfire M, Mandel C, et al. Antioxidant nutrient supplementation reduces the susceptibility of low density lipoprotein to oxidation in patients with coronary artery disease. J Am Coll Cardiol. 1997;30:392–9.

    Article  CAS  Google Scholar 

  16. Viroonudomphol D, Pongpaew P, Tungtrongchitr R. The relationships between anthropometric measurements, serum vitamin A and E concentrations and lipid profiles in overweight and obese subjects. Asia Pac J Clin Nutr. 2003;1:73–9.

    Google Scholar 

  17. Switzer BR, Atwood JR, Stark AH, et al. Plasma carotenoid and vitamins A and E concentrations in older African American women after wheat bran supplementation: effects of age, body mass and smoking history. J Am Coll Nutr. 2005;3:217–26.

    Article  Google Scholar 

  18. Silva LSVL, Veiga GVV, Ramalho RA. Association of serum concentrations of retinol and carotenoids with overweight in children and adolescents. Nutrition. 2007;23:392–7.

    Article  Google Scholar 

  19. Quaranta L, Nascimbeni G, Semenaro F, et al. Severe corneoconjunctival xerosis after biliopancreatic bypass for obesity (Scopinaro’s operation). Am J Ophthalmol. 1994;118:817–8.

    Article  CAS  Google Scholar 

  20. Huerta S, Rogers LM, Li Z, et al. Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity. Am J Clin Nutr. 2002;76:426–9.

    Article  CAS  Google Scholar 

  21. Hatizifotis M, Dolan K, Newbury L, Fielding G. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes Surg. 2003;4:655–7.

    Article  Google Scholar 

  22. Chae T, Foroozan R. Vitamin A deficiency in patients with a remote history of intestinal surgery. Br J Ophthalmol. 2006;90:955–6.

    Article  CAS  Google Scholar 

  23. Sarni RO, Ramalho RA. Serum retinol and total carotene concentrations in obese children. Med Sci Monit. 2005;11:510–4.

    Google Scholar 

  24. WHO. Obesity: preventing and managing the global epidemic. Report of WHO consultation on obesity. Geneva: World Health Organization; 1998.

    Google Scholar 

  25. NIH Consensus Development Conference Draft Statement. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–65.

    Article  Google Scholar 

  26. WHO. Global prevalence of vitamin A. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmers. Micronutrient Series, WHO/NUT. 10. Geneva: WHO; 1996.

    Google Scholar 

  27. Sommer A. La carencia de vitamina A y sus consecuencias. Guía práctica para la detección y el tratamiento Vitamin A deficiency and its consequences. Practical guide for detection and treatment). Genebra: OMS; 1995.

    Google Scholar 

  28. International Vitamin A Consultative Group (IVACG). IVACG Statement. Maternal night blindness: a new indicator of vitamin A deficiency. Washington, DC: IVACG; 2002.

    Google Scholar 

  29. Sauberlich HE, Hodges RE, Wallace DL, et al. Vitamin A metabolism and requirements in the human studied with the use of labeled retinol. Vitam Horm. 1974;32:251–75.

    Article  CAS  Google Scholar 

  30. IV Diretriz Brasileira Sobre Dislipidemias e Prevenção da Aterosclerose (IV Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis). Arq Bras Cardiol. 2007;88:s.1.

  31. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care. 2004;10:2444–9.

    Article  Google Scholar 

  32. Crerand CE, Wadden TA, et al. A comparison of weight histories in women with class III vs. class I–II obesity. Surg Obes Relat Dis. 2006;2:165–70.

    Article  Google Scholar 

  33. Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study 1922 to 1935. N Engl J Med. 1992;327:1350–5.

    Article  CAS  Google Scholar 

  34. Queiróz E, Ramalho RA, et al. Vitamin A status in diabetic children. Diabetes Nutr Metab. 2000;4:125–7.

    Google Scholar 

  35. West CE. Meeting requirements for vitamin A. Nutr Rev. 2000;58:341–5.

    Article  CAS  Google Scholar 

  36. Baltasar A. Definición: ¿Qué es la obesidad grave? (What is severe obesity?). In: Obesidad y Cirugía - como dejar de ser obeso (Obesity and Surgery—how not to be obese any longer). 1st ed. Madrid: Editora Arán; 2000. p. 15–21.

    Google Scholar 

  37. Polacow VO, Lancha AH Jr. Dietas hiperglicídicas: efeitos da substituição isoernergética de gordura por carboidratos sobre o metabolismo de lipídios, adiposidade corporal e sua associação com atividade física e com o risco de doença cardiovascular (Hyperglicidic diets: effects of isoenergetic substitutions of fat by carbohydrates on lipid metabolism, body adiposity and their association with physical activity and with the risk for cardiovascular disease). Arq Bras Endocrinol Metabol. 2007;51:389–400.

    Article  Google Scholar 

  38. Sorensen TI. The changing lifestyle in the world: body weight and what else? Diabetes Care. 2000;2:1–4.

    Google Scholar 

  39. Butte NF. The role of breastfeeding in obesity. Pediatr Clin North Am. 2001;1:189–98.

    Article  Google Scholar 

  40. Sarni RS, Kochi C, et al. Impact of vitamin A megadose supplementation on the anthropometry of children and adolescents with non-hormonal statural deficit: a double-blind and randomized clinical study. Int J Vitam Nutr Res. 2003;73:303–11.

    Article  CAS  Google Scholar 

  41. Matsuoka H. Endothelial dysfunction associated with oxidative stress in human. Diabetes Res Clin Pract. 2001;54:S65–72.

    Article  CAS  Google Scholar 

  42. Ramalho RA, Flores H, Accioly E, et al. Deficiência de vitamina A no Brasil (Deficiency of vitamin A in Brazil). Soc Iber Nutr. 2005.

  43. Mecocci P, Polidori MC, Troiand L, et al. Plasma antioxidants and longevity: a study on healthy centenarians. Free Radic Biol Med. 2000;28:1243–8.

    Article  CAS  Google Scholar 

  44. Rodriguez-Amaya DB. Food carotenoids: analysis, composition and alterations during storage and processing of foods. Forum Nutr. 2003;56:35–7.

    CAS  PubMed  Google Scholar 

  45. Higa KD, Boone KD, Ho T. Laparoscopic Roux en Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135:1029.

    Article  CAS  Google Scholar 

  46. Cruz M, Marimoto IMI. Intervenção nutricional no tratamento cirúrgico da obesidade mórbida: resultados de um protocolo diferenciado (Nutrition intervention in the surgical treatment of morbid obesity: results of a differentiated protocol). Rev Nutr. 2004;17:263–72.

    Article  Google Scholar 

  47. Rhode B, McLean LD. Vitamin and mineral supplementation after gastric bypass. In: Deitel M, editor. (Chapter 19 Update) Surgery for the morbidly obese patient. Toronto: F-D Communications; 2000.

    Google Scholar 

  48. Cambi MPC. Avaliação nutricional e de qualidade de vida em pacientes submetidos à cirurgia bariátrica Nutritional and life quality assessment of patients submitted to bariatric surgery). Master thesis of the Post-Graduation. Program - UFSC: Florianópolis; 2001.

  49. Blomhoff R. Transport and metabolism of vitamin A. Nutr Rev. 1994;52:13–23.

    Article  Google Scholar 

  50. Christian P, West JR, et al. Maternal night blindness increases risk of mortality in the first 6 months of life among infants in Nepal. J Nutr. 2001;131:1510–2.

    Article  CAS  Google Scholar 

  51. Zemora S, Diego J. Antioxidantes. Micronutrientes en lucha por la salud (Antioxidants. Micronutrients in fight for health). Rev Chil Nutr. 2007;34:17–26.

    Google Scholar 

  52. Karlsson J, Sjöström L, Sullivan M. Two-year follow up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity: Swedish Obese Subjects (SOS)—an intervention study of obesity. Int J Obes Relat Metab Disord. 2005;22:113–26.

    Article  Google Scholar 

  53. Carvalho OS, Moreira CLCB, et al. Cirurgia bariátrica cura síndrome metabólica? (Does bariatric surgery cure metabolic syndrome?). Arq Bras Endocrinol Metabol. 2007;51:78–85.

    Google Scholar 

  54. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program National Heart, Lung, and Blood Institute. Bethesda: National Institutes of Health NIH Publication; 2002.

    Google Scholar 

  55. Leborgne L, Maziere JC, Maziere C. Oxidative stress, atherogenesis and cardiovascular risk factors. Arch Mal Coeur Vaiss. 2002;9:805–14.

    Google Scholar 

  56. Serban MG, Negru T. Lipoproteins, lipidic peroxidation and total antioxidant capacity in serum of aged subjects suffering from hyperglycemia. Rom J Intern Med. 1998;36:65–70.

    CAS  PubMed  Google Scholar 

  57. Toikka JO, Ahotupa M, Viikari JS, et al. Constantly low HDL-cholesterol concentration relates to endothelial dysfunction and increased in vivo LDL-oxidation in healthy young men. Atherosclerosis. 1999;147:133–8.

    Article  CAS  Google Scholar 

  58. Baena RM, Campoy C, et al. Vitamin A, retinol binding protein and lipids in type 1 diabetes mellitus. Eur J Clin Nutr. 2002;56:44–50.

    Article  CAS  Google Scholar 

  59. Santos HS, Cruz WM. A terapia nutricional com vitaminas oxidantes e o tratamento quimioterápico oncológico (Nutritional therapy with oxidant vitamins and the oncological chimiotherapic treatment). Rev Bras Cancerol. 2001;3:303–8.

    Google Scholar 

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Authors and Affiliations

  1. Vitamin A Research Group, Universidade Federal do Rio de Janeiro, Rua Dona Mariana, 143/F11-Botafogo, Rio de Janeiro, Rio de Janeiro, CEP: 22280-020, Brazil

    Silvia Pereira

  2. General Surgery, American College of Surgeons, Chicago, IL, USA

    Carlos Saboya

  3. Bariatric Surgery, Brazilian Society of Bariatric Surgery and Metabolic, São Paulo, SP, Brazil

    Carlos Saboya

  4. General Surgery, International College of Surgeons, Chicago, IL, USA

    Carlos Saboya

  5. General Surgery, Brazilian College of Surgeons, Rio de Janeiro, RJ, Brazil

    Carlos Saboya

  6. Vitamin A Research Group, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Gabriela Chaves

  7. Instituto de Nutrição Josué de Castro, Vitamin A Research Group, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Andréa Ramalho

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  1. Silvia Pereira
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  2. Carlos Saboya
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  4. Andréa Ramalho
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Correspondence to Silvia Pereira.

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Pereira, S., Saboya, C., Chaves, G. et al. Class III Obesity and its Relationship with the Nutritional Status of Vitamin A in Pre- and Postoperative Gastric Bypass. OBES SURG 19, 738–744 (2009). https://doi.org/10.1007/s11695-008-9478-y

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