Introduction: Bariatric surgery (BS) is an effective therapeutic approach for obese patients. It is associated with important gastrointestinal anatomic changes, predisposing these subjects to altered nutrient absorption that impact phosphocalcium metabolism. This study aims to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. Methods: Retrospective unicentric study of 1431 obese patients who underwent metabolic surgery between January/2010 and June/2017 and who were followed for, at least, a year. In this group, 185 subjects were submitted to laparoscopic adjustable gastric banding (LAGB), 830 underwent Roux-en-Y gastric bypass (RYGB) and 416 sleeve gastrectomy (SG). Data comprising 4 years of follow-up were available for 333 patients. We compared the clinical and analytical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH˃69pg/mL), taking also into account the type of surgery. A multiple logistic regression was performed to study the predictors of SHPT after BS. Results: The overall prevalence of SHPT before surgery was 24.9%, 11.2% one year after surgery and 21.3% four years after surgery. At 12 months after surgery, LAGB had the highest prevalence of patients with SHPT (19.4%, N=36), RYGB had 12.8% (N=274) and SG 5.3% (N=131). At 48 months after surgery, RYGB had the highest prevalence of SHPT (27.0%, N=222), LAGB had 13.2% (N=53) and SG 6.9% (N=58). Multi-variate logistic analysis showed that increased body mass index and age, decreased levels of vitamin D and RYGB were independent predictors of SHPT one year after surgery. The only independent predictor of SHPT four years after surgery was RYGB. Conclusion: The prevalence of SHPT is considerably higher before and four years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.
Garrido, S., Murta, A. G., Moreira, A., Ferreira, M. J., and Angélico, M. M. 2008. Horse mackerel (Trachurus trachurus) stomach fullness off Portugal: index calibration and spatio-temporal variations in feeding intensity. – ICES Journal of Marine Science, 65: 1662–1669. An index for stomach fullness used in the routine biological sampling of horse mackerel from Portuguese waters was calibrated about the correspondent stomach mass. The fullness scale comprises four levels (1, empty; 2, <50% filled; 3, >50% filled; 4, bursting) that are easily attributed to whole stomachs during the sampling process. Significant differences were found among the four levels of the fullness scale in their relative stomach masses, indicating that the index can be used for the semi-quantitative analysis of feeding intensity in this species. The fullness index was applied to study spatio-temporal variations in horse mackerel feeding off the Portuguese coast, using data collected from 1985 to 2006 on commercial vessels and research cruises. There was no significant difference in feeding intensity between sexes. Smaller horse mackerel and those in the resting stage of reproduction fed more intensively than larger and spawning fish. Feeding intensities of fish from the southern and northwest coasts of Portugal were greater than for those captured along the southwest coast. Horse mackerel feeding intensity was greater at dawn and varied seasonally, being higher during spring and autumn and lower during winter. Interannual variation in feeding intensity of horse mackerel captured along the west coast of Portugal revealed a significant but slight decrease in recent years.
Background: An association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity. Aim: To evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity. Methods: Patients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively. Results: We observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p<0.01) and a positive association between free triiodothyronine levels and FLI (OR 1.48; p = 0.022). Concerning liver function, we found a positive association between total bilirubin and free thyroxine levels (b = 0.18 [0.02 to 0.35]; p = 0.033) and a negative association between total bilirubin and free triiodothyronine levels (b = −0.07 [−0.14 to −0.002]; p = 0.042). Conclusion: Higher levels of TSH and free triiodothyronine may be associated with a higher risk of NAFLD, particularly steatosis, in patients with morbid obesity.
Introduction: The association between obesity and depression has been repeatedly established. However, little is known about the impact that the diagnosis of depression before bariatric surgery (DDBS) may have on weight loss. Objective: To evaluate the impact of DDBS on weight outcomes. Methods: Retrospective study of patients submitted to BS. Patients with no weight, no current medication data, or those submitted to revision surgery were excluded. Patients were considered to have DDBS based on taking antidepressants prior to BS or if there was a medical history of past or current depression. Patients with and without a depression history were compared using independent t test. A multivariate logistic regression model was created to evaluate predictors of weight variation (variables included: age, sex, and type of surgery). Results: A total of 616 patients did not have a history of depression and 230 had DDBS. There was a statistically significant difference in the BMI variation between groups. On average, individuals with DDBS lost 1.4 kg/m 2 less than those without DDBS. In the multivariate analysis, the group with DDBS, compared with the group without DDBS, presented on average less -0.9 kg/m 2 (95% CI -1.7 to -0.2, p = 0.018) BMI variation. Conclusion: DDBS is a predictor of lower weight loss after the surgical procedure. Even after adjusting for confounding variables such as age, sex, and BS type, this effect remains.
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