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Obesity in the COVID era: A global health challenge.
Rubio Herrera, MA, Bretón Lesmes, I
Endocrinologia, diabetes y nutricion. 2021;(2):123-129
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Abstract
Obesity is a chronic disease that leads to an increased risk of mortality and morbidity, and the impact of the COVID-19 pandemic may create a new health challenge. There is clear evidence showing that some biological and social factors associated with obesity involve an increased risk of COVID-19 infection, hospitalization, and greater severity compared to people with normal weight. Undoubtedly, obesity involves a low-grade proinflammatory state that produces a dysregulation of the immune system that compromises its ability to respond to respiratory infection by COVID-19 and so produces a worsening of the disease. In this review, the main epidemiological and pathophysiological data that associate obesity with COVID-19 are described.
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Bariatric surgery and vitamin D: key messages for surgeons and clinicians before and after bariatric surgery.
Peterson, LA
Minerva chirurgica. 2016;(5):322-36
Abstract
Obesity is the most widespread nutritional problem globally. Bariatric surgery is the preeminent long-term obesity treatment. Bariatric procedures manipulate the intestines to produces malabsorption and/or restrict the size of the stomach. The most enduring bariatric procedure is the Roux-en-Y gastric bypass, which utilizes both restriction (small stomach pouch) and malabsorption (duodenum bypass). The in-vogue procedure is the vertical sleeve gastrectomy - resection of the greater curvature of the stomach (predominantly restrictive). Malabsorptive procedures function by decreasing nutrient absorption, primarily fat and fat-soluble nutrients (vitamins A, D, E, and K). Most studies of vitamin D status in bariatric surgery candidates reported a prevalence of over 50% vitamin D deficiency (<50 nmol/L), enduring post-operatively with one study reporting 65% deficient at 10 years post-bariatric surgery. Obesity is associated with chronic inflammation, which may contribute to adverse surgical outcomes, e.g. poor healing and infection. Since vitamin D deficiency is also associated with chronic inflammation, obese individuals with vitamin D deficiency have extraordinary risk of adverse surgical outcomes, particularly delayed wound healing and infection due to the role of vitamin D in re-epithelialization and innate immunity. When the risk of adverse surgical outcomes in obesity is combined with that of vitamin D deficiency, there is likely an additive or potentially a synergistic effect. Furthermore, deficiency in fat-soluble vitamins, such as vitamin D, is considered a metabolic complication of bariatric surgery. Thus, determining the vitamin D status of bariatric surgery candidates and amending it preoperatively may prove greatly beneficial acutely and lifelong.
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Dermatological complications after bariatric surgery: report of two cases and review of the literature.
Zouridaki, E, Papafragkaki, DK, Papafragkakis, H, Aroni, K, Stavropoulos, P
Dermatology (Basel, Switzerland). 2014;(1):5-9
Abstract
Bariatric surgery aims at weight reduction of severely obese patients. The Roux-en-Y technique is one of the most common bariatric procedures and is occasionally accompanied by nutrient insufficiencies and metabolic changes. According to the literature, skin architecture and immunity change after bariatric surgery and may lead to inflammation and increased susceptibility to pathogens. Additionally, vitamin and mineral deficiencies frequently develop in these patients and affect the skin's defense mechanisms, possibly contributing to dermatological complications. Knowledge and recognition of skin changes after bariatric surgery make an important asset for the dermatologist and help in the proper treatment of these patients. We report 2 cases of infectious skin lesions where vitamin and trace element deficiencies have possibly contributed to their persistence and resistance to traditional treatments.
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Non-alcoholic steatohepatitis in morbidly obese patients.
Tran, A, Gual, P
Clinics and research in hepatology and gastroenterology. 2013;(1):17-29
Abstract
The hepatic complications of morbid obesity range from steatosis to steatohepatitis (Non-alcoholic steatohepatitis [NASH]), fibrosis, cirrhosis and finally hepatocellular carcinoma. The pathophysiological mechanisms of the progression of a normal liver to a liver showing steatosis and then steatohepatitis are complex, including, per se, insulin-resistance, iron accumulation, oxidative stress and hepatocyte death. An imbalance in anti- and pro-inflammatory factors may be the trigger. These factors can originate from intra- or extrahepatic sites, particularly the adipose tissue and the gut. This review will provide insight into the current diagnosis and understanding of hepatic inflammation including non-invasive markers of NASH (markers of hepatocyte death), intrahepatic mechanisms (regulation of the immune and inflammatory response, hepatocellular iron deposition, hepatocyte death) and extrahepatic factors (from adipose tissue and gut) in morbidly obese patients.
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5.
Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery.
Agha-Mohammadi, S, Hurwitz, DJ
Plastic and reconstructive surgery. 2008;(6):1901-1914
Abstract
BACKGROUND Bariatric surgery is currently the most effective method of sustainable weight loss for the morbidly obese patient. In the months to years that follow, many patients develop nutritional deficiencies of proteins, vitamins, and minerals as they present for plastic surgery and body contouring operations. METHODS The aim of this review is to highlight the nutritional deficiencies of postbariatric patients as related to their planned body contouring surgery. This review was prepared by an extensive search of the PubMed and Ovid databases for terms such as "bariatric surgery," "nutritional deficiency," "wound healing," and "immune response." RESULTS The current review indicates that many of the deficient macronutrients and micronutrients of postbariatric patients are implicated in wound healing and optimal immune response. CONCLUSIONS Although the optimal nutrient intake to promote wound healing is unknown, it is clear that proteins, vitamin A, vitamin C, vitamin B complex, arginine, glutamine, iron, zinc, and selenium can have significant beneficial effects on wound healing and optimization of the immune system. Furthermore, vitamin B complex can reduce homocysteine levels, which is inversely associated with the risk of venous thrombosis and endothelial cell dysfunction. The authors' preliminary experience with a nutritional blend that contains all of the aforementioned ingredients has significantly reduced their complication rates.