Recorrência de ganho de peso de indivíduos submetidos à cirurgia bariátrica de acordo com diferentes pontos de corte e suas associações com variáveis de risco cardiometabólicos

Abstract

Introduction: Bariatric surgery is effective in treating severe obesity, but recurrent weight gain (WR) after the procedure is a growing concern. This phenomenon can impact patients’ metabolic health, with an increased risk for comorbidities. The lack of consensus on cutoff points to define weight recurrence and the effects on comorbidities is still a gap in the literature. Objective: To evaluate the percentages of WR in patients who underwent bariatric surgery more than two years ago through the Unified Health System (SUS) and its association with the return of comorbidities or the emergence of new metabolic alterations. Methods: This is a cross- sectional observational study carried out with 95 patients who underwent bariatric surgery from 2011 to 2019 at the Hospital Geral Público de Palmas, Tocantins, Brazil. Data collection was performed in person and remotely, with evaluation of variables such as surgery time, surgical technique adopted, socioeconomic status, and sex. The anthropometric variables collected were current weight, weight at the time of surgery, nadir weight (lowest weight after bariatric surgery) and height. From these, derived measures were calculated such as: current, minimum and preoperative body mass index; preoperative excess weight, current excess weight; current weight loss (% and kg). The metabolic variables analyzed were total cholesterol and fractions, triglycerides, complete blood count, blood glucose, insulin, ferritin, zinc, HOMA IR and TyG index (Triglycerides/Glucose). Vitamins D, B9 and B12 were also measured. PR was calculated considering the weight gain after nadir weight, and analyzed in different percentages (15%, 25%, 35%, 45%), compared with each other and associated with metabolic and biochemical parameters. Results: Individuals with a PR greater than 15% had significantly higher values of Body Mass Index (BMI) and insulin resistance by HOMA-IR. In turn, those with a PR greater than 25% had broader changes compared to the PR of 15%, including reduced ferritin levels, higher HOMA-IR values and a significant increase in the TyG index. With a PR greater than 35%, it was identified for the first time that the mean triglyceride levels showed a significant increase. However, no additional changes were observed when we compared PR from 35% to 45%. Conclusion: The recurrence of 15% weight gain after bariatric surgery is already capable of causing significant metabolic changes such as insulin resistance, and therefore, it is not necessary to wait for higher PR values to consider intervention measures that prevent the recurrence of weight and obesity.