Concordance between Different Criteria for Metabolic Syndrome in Peruvian Adults Undergoing Bariatric Surgery

Background: Metabolic Syndrome (MetS) is a clinical entity that has been linked to several non-communicable diseases. There are various consensuses to determine its presence, such as the IDF, ALAD, Harmonized, AHA/NHLBI, NCEP-ATP III or AACE criteria. However, there is currently no standardization to properly identify it. Objective: To assess the diagnostic concordance between different criteria for MetS in Peruvian adults undergoing bariatric surgery. Methods: We conducted a secondary analysis of the institutional database of a bariatric clinic located in Lima, Peru. We obtained data from adults between 18–59 years who underwent bariatric surgery (Roux-en-Y Gastric Bypass or Sleeve Gastrectomy). According to the Kappa coefficient, a heatplot was designed to analyze the concordance of the criteria. Results: An almost perfect concordance was found between all criteria except AACE. The highest kappa coefficient (κ = 0.980) was recorded between the IDF and ALAD criteria using all the sample. Similar results were obtained when we stratified by sex. Conclusions: This study shows that, excluding the AACE, different criteria for metabolic syndrome could be used in Latino adults undergoing bariatric surgery with similar results. Given the postoperative implications, we believe that IDF and ALAD would be the best options in our population.Revisión por pare

Balón intragástrico ingerible Elipse®: Primera experiencia en Perú

Letter to the Editor (without abstract)Carta al Editor (sin resumen

The Elipse® swallowable intragastric balloon: First experience in Peru

Carta al editorRevisión por pare

"Percentage of excess body mass index loss and cardiometabolic risk reduction in Peruvian adults undergoing sleeve gastrectomy"

"Objective: To assess the association between the percentage of excess body mass index loss (%EBMIL) and cardiometabolic risk reduction in Peruvian adults undergoing laparoscopic sleeve gastrectomy (LSG). Methods: Retrospective cohort study conducted with adult patients who underwent LSG in a bariatric clinic during 2016–2020. The outcome variable was cardiometabolic risk change (expressed in Δ) 1 year after LSG. To that effect, the variables total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, very LDL (VLDL) cholesterol, triglycerides, glucose, insulin, and HOMA-IR at baseline and after 12 months were considered. The exposure variable was %EBMIL. Crude and adjusted β coefficients were estimated with linear regression models. Results: Of the 110 patients analyzed, 68.2% were women, and the median patient age was 34.5 years. In the model adjusted for sex, age, and baseline BMI, we noted that each 25% increase in %EBMIL resulted in a decrease in the values for total cholesterol, LDL, triglycerides, and insulin by 10.36 mg/dL (p < 0.001), 7.98 mg/dL (p = 0.001), 13.35 mg/dL (p = 0.033), and 3.63 uU/mL (p = 0.040), respectively. Conclusion: %EBMIL was associated with a decrease in total cholesterol, LDL, triglycerides, and insulin levels, which could suggest a favorable cardiometabolic evolution during the first 12 months following LSG.

Hiperhidrosis esencial, recomendaciones para su tratamiento Essential hyperhidrosis, recommendations for its treatment

La hiperhidrosis esencial, más que un aumento profuso y desproporcionado en la producción y excreción de sudor, de manos y pies, u otras zonas, es una entidad clínica propia, con una sintomatología específica y una manera de sudar cuyas características la hacen patonegmónica. Etiológicamente no está confirmado su origen, pero sí está claro que constituye un problema de salud más frecuente, y a su vez desconocido y subvalorado, que otras tantas enfermedades. Afortunadamente en la actualidad existe un interés científico internacional en el tema y la cirugía se ha convertido en una herramienta útil, considerada esta la mejor opción de tratamiento. Algunos efectos indeseables en su evolución posoperatoria ensombrecen el pronóstico y motivan a los investigadores a buscar variantes técnicas que permitan mejorar los resultados que se tienen hoy. Con este mismo interés se celebra en el Centro Nacional de Cirugía de Mínimo Acceso un taller nacional e internacional de hiperhidrosis cada año. En los últimos 3 años se han realizado reuniones de consensos al final de estos eventos científicos, con los profesares nacionales y foráneos invitados. Las conclusiones de estas reuniones constituyen el motivo de esta presentación, y tiene el objetivo de protocolizar su tratamiento para evitar al máximo efectos indeseables o resultados negativos.The essential hyperhidrosis more than a profuse and disproportionate increase in production and excretion of sweat in hands and feet and other sites, is an own clinical entity with a specific symptomatology and a way of to sweat whose features becomes pathognomonic. From the etiological point of view its origin is not confirmed but it is clear that it is a frequent health problem and in turn unknown and undervalued than many other diseases. Fortunately nowadays there is an international scientific interest on this subject and surgery becomes a useful tool, considered it as the better option of treatment. Some undesirable effects in its postoperative evolution cast a shadow on the prognosis and motivate researchers to look for techniques variants allowing for improve the current results. With this same interest in the National Center of Minimal Access a national and international workshop on hyperhidrosis is held each year. In past three years at the end of these scientific events consensus meeting have been held together with the invited national and foreign professors. Conclusions from these meeting are the objective of present paper to add its treatment to protocol avoiding most of undesirable effects or the negative effects

Latin American Research on Bariatric Surgery: a Bibliometric Study

We performed a bibliometric analysis of Latin American documents published between 1984 to 2019 in Scopus-indexed journals. A total of 1856 documents were analyzed. The annual scientific production was 64 documents per year, with an annual increase rate of 15.9%. The countries with the highest scientific production on BS were Brazil (64.7%) and Chile (14.5%). Most of the publications were original (76.6%) and review articles (11.9%). The journal with the highest publication record was “Obesity Surgery” (25.8%). The extra-regional collaboration was mainly with the USA. In conclusion, Latin American scientific production on BS has shown a significant increase in recent years. However, more participation is needed, fostering intra-regional collaboration and involving universities and health institutions in BS research

Diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery

Background: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent liver disease, closely related with metabolic risk factors such as obesity, insulin resistance, dyslipidemia, diabetes mellitus, and metabolic syndrome. In this context, γ-Glutamyl transpeptidase (GGT) and high-density lipoprotein cholesterol (HDL-C) have shown correlations with steatosis severity and metabolic syndrome, respectively. This positions the GGT/HDL-C ratio as a potential diagnostic indicator for NAFLD. Objective: To assess the diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery. Methods: We conducted an analytical cross-sectional study, designed as a diagnostic test evaluation. A secondary database of 249 adults with obesity was analyzed. The optimal cut-off point was ascertained using three methodologies, and five adjustment models were constructed for the total population, further stratified by sex. Results: The optimal cut-off point was 20.5 U/mmol and the AUC of the ratio was 0.81 (95% CI: 0.64–0.98), with sensitivity and specificity being 82.5% and 77.8%, respectively. In the overall group with an elevated GGT/HDL-C ratio, the prevalence of NAFLD increased by 14% (PR: 1.14; 95% CI: 1.04–1.33). Specifically, women displaying this altered ratio showed a 19% increased prevalence (PR: 1.19; 95% CI: 1.07–1.42) compared to those with normal values. Conclusions: The GGT/HDL-C ratio is a promising biomarker for the diagnosis of NAFLD in an adult population living with obesity.Revisión por pare

Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) &ge;30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 &plusmn; 10.3 years and mean hemoglobin and albumin values of 14.0 &plusmn; 1.5 g/dL and 4.6 &plusmn; 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26&ndash;2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24&ndash;3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35&ndash;4.35; p = 0.003), participants with a BMI &ge;40 kg/m2 (aPR = 1.68; 95%CI: 1.09&ndash;2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01&ndash;2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37&ndash;14.32; p &lt; 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37&ndash;14.32; p &lt; 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52&ndash;0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery