NÍVEIS DE VITAMINA D E PERFIL LIPÍDICO EM PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA

Nascimento, Isabelle Maria Cabral do; Padilha, Bruna Merten; Araujo, Maria Lucia Diniz; Silva, Palena Cabral da; Noronha, Gisele Almeida de; Cabral, Poliana Coelho; Ferraz, Álvaro Antonio Bandeira

Acessibilidade / Reportar erro

Brasil

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • ABCD, arq. bras. cir. dig. 36 • 2023 • https://doi.org/10.1590/0102-672020230035e1753 copiar

NÍVEIS DE VITAMINA D E PERFIL LIPÍDICO EM PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

RACIONAL:

Deficiências vitamínicas, minerais e metabólicas ocorrem no pós-operatório de cirurgia bariátrica, a curto e longo prazo, sendo intercorrências preocupantes.

OBJETIVOS:

Avaliar a associação dos níveis séricos de vitamina D com o perfil lipídico, em pacientes obesos submetidos à cirurgia bariátrica.

MÉTODOS:

Série de casos de pacientes atendidos de 2010 até 2018, em hospital privado de média e alta complexidade, submetidos à cirurgia bariátrica pelas técnicas da gastrectomia vertical e derivação gástrica em Y de Roux, acompanhados pelo mesmo cirurgião. Foram coletados dados sociodemográficos, clínicos, dados laboratoriais e antropométricos no pré-operatório, 6 meses, 12 meses e 24 meses após cirurgia.

RESULTADOS:

Foram acompanhados 156 indivíduos, maioria sexo feminino (75,6%), comorbidades mais frequentes foram esteatose hepática (76,3%) e hipertensão (48,27). Em relação aos níveis de vitamina D pré-operatórios, apenas 18,9% da população apresentaram níveis satisfatórios (=30 ng/mL). Observou-se redução do peso e melhora do perfil lipídico pós-cirúrgico. Sobre as correlações entre o perfil lipídico e concentração de vitamina D foram observadas correlações significativas apenas na amostra que passou pela técnica cirúrgica derivação gástrica em Y de Roux: correlação negativa entre o colesterol total e vitamina D após 2 anos de cirurgia; correlação positiva entre triglicerídeo e vitamina D 1 ano pós-operatório; e correlação negativa entre HDL e vitamina D 2 anos pós-operatório.

CONCLUSÕES:

é essencial acompanhar os níveis de vitamina D e perfil lipídico no pré e pós-operatório de forma rotineira a fim de evitar danos relacionados a deficiência dessa vitamina.

DESCRITORES:
Cirurgia Bariátrica; Obesidade; Vitamina D

		Follow-up			Losses			p^* * Pearson's χ² test.
		n	%	95%CI	n	%	95%CI	p^* * Pearson's χ² test.
Gender
	Male	38	24.4	17.3–31.8	7	13.5	6.0–24.4	0.10
	Female	118	75.6	68.2–82.7	45	86.5	75.6–94.0	0.10
Age
	<45 years	96	61.5	53.8–68.9	39	75.0	62.2–85.4	0.08
	≥45 years	60	38.5	31.1–46.2	13	25.0	14.6–37.8	0.08
Hypertension
	Yes	76	48.7	41.2–56.6	20	38.5	26.0–52.0	0.20
	No	80	51.3	43.4–58.8	32	61.5	48.0–74.0	0.20
Diabetes
	Yes	48	30.8	23.7–38.0	9	17.3	8.7–29.0	0.06
	No	108	69.2	62.0–76.3	43	82.7	71.0–91.3	0.06
Dyslipidemia
	Yes	49	31.4	23.9–38.9	16	30.8	19.4–44.0	0.93
	No	107	68.6	61.1–76.1	36	69.2	56.0–80.6	0.93
Hepatic steatosis
	Yes	119	76.3	68.7–82.8	40	76.9	64.3–86.9	0.92
	No	37	23.7	17.2–31.3	12	23.1	13.1–35.7	0.92
Total cholesterol
	Undesirable	85	54.8	47.0–62.5	32	61.5	48.0–74.0	0.40
	Desirable	70	45.2	37.5–53.0	20	38.5	26.0–52.0	0.40
HDL
	Undesirable	46	29.9	23.0–37.4	15	28.8	17.8–42.0	0.89
	Desirable	108	70.1	62.6–77.0	37	71.2	58.0–82.2	0.89
LDL
	Undesirable	49	31.6	24.6–39.2	18	34.6	22.6–48.1	0.69
	Desirable	106	68.4	60.8–75.4	34	65.4	51.9–77.4	0.69
Triglycerides
	Undesirable	62	40.0	32.5–47.8	21	40.4	27.7–53.9	0.96
	Desirable	93	60.0	52.2–67.5	31	59.6	46.1–72.3	0.96
Vitamin D
	Deficient	57	38.5	30.9–46.5	13	26.0	15.2–39.2	0.28
	Insufficient	63	42.6	34.8–50.6	26	52.0	38.3–65.5
	Sufficient	28	18.9	13.2–25.7	11	22.0	12.1–34.7

		Sleeve gastrectomy					Roux-en-Y gastric bypass
		n	Mean	SD	95%CI	p^* * ANOVA.	n	Mean	SD	95%CI	p^* * ANOVA.
Weight		60					76
	Preoperative		104.13^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	13.71	100.59–107.67	<0.001		116.83^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	22.38	111.72–121.94	<0.001
	Postoperative 6 months		80.66^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.31	77.73–83.58			89.10^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	17.07	85.19–93.00
	Postoperative 12 months		70.27^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.50	67.29–73.24			76.60^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	15.16	73.13–80.06
	Postoperative 24 months		71.48^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.75	68.45–74.52			75.22^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	15.99	71.57–78.87
BMI		60					76
	Preoperative		39.09^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.50	38.19–40.00	< 0.001		42.28^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	5.11	41.11–43.44	<0.001
	Postoperative 6 months		30.31^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.39	29.44–31.19			32.39^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	4.79	31.30–33.49
	Postoperative 12 months		26.41^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.33	25.55–27.27			27.68^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.87	26.80–28.56
	Postoperative 24 months		26.83^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.45	25.94–27.72			27.11^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.99	26.20–28.02
Total Cholesterol		52					65
	Preoperative		201.87^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.12	190.98–212.76	0.011		194.90^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.81	185.04–204.77	<0.001
	Postoperative 6 months		185.69^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.67	176.60–194.79			161.34^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	33.21	153.11–169.57
	Postoperative 12 months		192.21^ab a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	33.18	182.97–201.45			157.08^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	30.39	149.54–164.61
	Postoperative 24 months		197.31^ab a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.16	186.41–208.21			161.94^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	31.43	154.15–169.73
HDL		37					61
	Preoperative		50.37^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.06	46.35–54.39	<0.001		44.88^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.09	42.04–47.72	<0.001
	Postoperative 6 months		50.48^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	13.21	46.08–54.88			42.04^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	9.74	39.54–44.53
	Postoperative 12 months		58.92^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	14.29	54.16–63.68			49.25^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.41	46.07–52.43
	Postoperative 24 months		64.37^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	14.85	59.42–69.33			55.27^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.84	51.98–58.56
LDL		37					61
	Preoperative		125.87^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.89	114.90–136.83	0.088		117.12^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.31	108.84–125.39	<0.001
	Postoperative 6 months		118.29^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	28.05	108.94–127.65			97.90^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	27.80	90.78–105.02
	Postoperative 12 months		114.54^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	26.25	105.79–123.30			90.16^b.c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	25.06	83.74–96.58
	Postoperative 24 months		111.91^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.66	98.69–125.14			89.93^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	24.36	83.69–96.17
Triglycerides		52					64
	Preoperative		160.77^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	86.12	136.79–184.75	<0.001		167.07^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	80.19	147.04–187.10	<0.001
	Postoperative 6 months		100.31^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	34.15	90.80–109.82			104.16^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	51.89	91.19–117.12
	Postoperative 12 months		90.79^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	35.78	80.83–100.75			83.44^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.58	75.30–91.57
	Postoperative 24 months		99.58^b,c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	62.74	82.11–117.04			87.05^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	35.88	78.08–96.01
Vitamin D		33					40
	Preoperative		21.82^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	6.70	19.44–24.19	<0.001		23.26^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	6.74	21.11–25.42	0.073
	Postoperative 6 months		27.67^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.96	24.49–30.85			25.26^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.08	22.68–27.85
	Postoperative 12 months		27.56^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	7.33	24.96–30.16			26.11^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.06	23.53–28.69
	Postoperative 24 months		26.81^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.49	23.80–29.82			26.35^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.68	23.58–29.13

Lipid profile	Time	Preoperative	Post-operative 6 months	Post-operative 12 months	Post-operative 24 months
Lipid profile	Time	Vitamin D
TC	SG	−0,15	−0,10	−0,12	−0,19
TC	RYGB	0,09	−0,20	0,03	-0,31 ^* * Spearman's Rho coefficients (p<0.05).
TG	SG	−0,12	−0,19	−0,06	−0,13
TG	RYGB	−0,19	0,01	0,24 ^* * Spearman's Rho coefficients (p<0.05).	0,01
HDL	SG	−0,09	0,09	−0,03	0,07
HDL	RYGB	−0,16	−0,11	−0,07	-0,32 ^* * Spearman's Rho coefficients (p<0.05).
LDL	SG	−0,10	−0,11	−0,14	0,03
LDL	RYGB	−0,04	−0,16	0,03	−0,24

Colégio Brasileiro de Cirurgia Digestiva Av. Brigadeiro Luiz Antonio, 278 - 6° - Salas 10 e 11, 01318-901 São Paulo/SP Brasil, Tel.: (11) 3288-8174/3289-0741 - São Paulo - SP - Brazil
E-mail: revistaabcd@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Isabelle Maria Cabral do Nascimento. E-mail: isabellecabral1@hotmail.com