Fat, muscle, and bone are endocrine organs capable of affecting the metabolic profile and cardiovascular risk. Relating these components is important to the establishment of early intervention strategies for overweight patients.
This study aimed to evaluate the influence of body mass components on the metabolic profile and cardiovascular risk in the preoperative period of bariatric surgery.
A cross-sectional study was conducted with patients admitted for bariatric surgery at a university hospital in the city of Recife, Brazil, between 2018 and 2019. Body composition was determined using dual-energy x-ray absorptiometry. Cardiovascular risk was assessed using the Framingham risk score. Data were collected on anthropometric, clinical, and lifestyle characteristics. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), blood glucose, and vitamin D were determined using the standard methods of the hospital laboratory.
A total of 60 patients were analyzed, 86.7% of whom had comorbidities, 33.3% had moderate/high cardiovascular risk, and 71.4% had vitamin D insufficiency/deficiency. Lower lean body mass (adjusted PR 3.24; 95%CI 1.19–5.77) was independently associated with the severity of obesity. The body mass index and waist circumference were negatively correlated with lean body mass (r=-0.52; p<0.01)/r=-0.36; p<0.01). Lean body mass was negatively correlated with fat mass (r=-0.26; p<0.05), trunk fat (r=-0.29; p<0.05), fasting glucose (r=-0.26; p<0.05), and bone mineral density (r=-0.26; p<0.05). A total of 84.2% of individuals with less trunk fat tended to have low cardiovascular risk (p=0.05). However, physical inactivity (adjusted PR 2.14; 95%CI 1.19–5.54) and the risk of alcohol dependence (adjusted PR 2.41; 95%CI 1.76–4.15) were the only variables independently associated with cardiovascular risk.
Obese patients in the preoperative period of bariatric surgery with less trunk fat tended to have low cardiovascular risk. However, the other components of body mass were also not associated with cardiovascular risk.
Body mass index (BMI) has some limitations for nutritional diagnosis since it does not represent an accurate measure of body fat and it is unable to identify predominant fat distribution.
To develop a BMI based on the ratio of trunk mass and height.
Fifty-seven patients in preoperative evaluation to bariatric surgery were evaluated. The preoperative anthropometric evaluation assessed weight, height and BMI. The body composition was evaluated by bioimpedance, obtaining the trunk fat free mass and fat mass, and trunk height. Trunk BMI (tBMI) was calculated by the sum of the measurements of the trunk fat free mass (tFFM) and trunk fat mass (tFM) in kg, divided by the trunk height squared (m2)). The calculation of the trunk fat BMI (tfBMI) was calculated by tFM, in kg, divided by the trunk height squared (m2)). For the correction and adjustment of the tBMI and tfBMI, it was calculated the relation between trunk extension and height, multiplying by the obtained indexes.
The mean data was: weight 125.3±19.5 kg, height 1.63±0.1 m, BMI was 47±5 kg/m2) and trunk height was 0.52±0,1 m, tFFM was 29.05±4,8 kg, tFM was 27.2±3.7 kg, trunk mass index was 66.6±10.3 kg/m², and trunk fat was 32.3±5.8 kg/m². In 93% of the patients there was an increase in obesity class using the tBMI. In patients with grade III obesity the tBMI reclassified to super obesity in 72% of patients and to super-super obesity in 24% of the patients.
The trunk BMI is simple and allows a new reference for the evaluation of the body mass distribution, and therefore a new reclassification of the obesity class, evidencing the severity of obesity in a more objectively way.
Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status.
Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation.
Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity.
A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia.
The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.
HEADINGS:
Body mass index, Body composition, Liver transplantation, Sarcopenia,
In the last decades, numerous studies have confirmed the importance of lactate - by-product to the nutrient signal of the intracellular redox state - to regulatory functions in energy metabolism.
To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile.
Twenty-four people with severe obesity (BMI=40 kg/m2) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry.
The initial lactate level was 2.5±1.1 mmol/l and returned to normal level (1.9±3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein.
There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.
Desenvolvido por Surya MKT