Vitamin A Research Group, Universidade Federal do Rio de Janeiro, Rua Dona Mariana, 143/F11-Botafogo, Rio de Janeiro, Rio de Janeiro, CEP: 22280-020, Brazil.
Obes Surg. 2009 Jun;19(6):738-44. doi: 10.1007/s11695-008-9478-y. Epub 2008 Apr 8.
Epidemiological findings have shown the rise of the prevalence of obesity in several segments of the world population, and more recent evidences point to a possible association with vitamin A deficiency (VAD). The aim of this study was to investigate vitamin A nutritional status in individuals with class III obesity in the preoperative period and 30 and 180 days after Roux-en-Y gastric bypass, correlating these findings with lipid profile and body mass index (BMI).
The sample was composed of class III obese individuals, males and females, in the preoperative period (T1) and 30 (T2) and 180 days (T3) after bariatric surgery with 5,000 IU of supplementation of retinol acetate. Vitamin A nutritional status was assessed through biochemical indicators (retinol and beta-carotene serum levels), which were quantified by high-performance liquid chromatography with an inadequacy cutoff of <1.05 micromol/L and >or=40 microg/dL, respectively.
Out of the 114 assessed patients, the mean age was 36.9+/-11.6 years and BMI was >or=40 kg/m2. The prevalence of VAD was 14%, being 37.5% in T1, 50.8% and 67.8% in T2, and 52.9% and 67% in T3, according to retinol and serum beta-carotene, respectively. A decrease of retinol and beta-carotene serum levels was observed with BMI increase in T1. An increase of very-low-density lipoprotein cholesterol (VLDLc) and triglycerides was verified with the increase of retinol, being VLDLc in T3 and triglycerides in T1 and T2. In T1, high-dense lipoprotein cholesterol presented a positive and significant correlation with beta-carotene and a negative and significant correlation in T3.
High prevalence of VAD in the preoperative period and in 30 and 180 postoperative days, even during supplementation, with higher inadequacy of beta-carotene in all the three studied time periods, probably occurred because of its bioconversion to retinol due to the increased demand to which those individuals were exposed. It is suggested that the oral intake supplementation does not present the expected impact, and the need of assessing the nutritional status of vitamin A in the pre- and postoperative Roux-en-Y gastric bypass is emphasized. High prevalence of VAD in T1, with severity in T2 and T3, corroborates the utilization of the cutoff of <1.05 micromol/L as a VAD marker in the studied segment and reinforces its utilization as a tool in clinical practice to identify VAD in morbid obese patients who underwent bariatric surgery.
流行病学研究结果表明，世界人口中肥胖的流行率有所上升，最近的证据表明，肥胖与维生素 A 缺乏（VAD）之间可能存在关联。本研究旨在探讨术前及 Roux-en-Y 胃旁路术后 30 天和 180 天的 III 类肥胖患者的维生素 A 营养状况，并将这些发现与血脂谱和体重指数（BMI）相关联。
该样本由术前（T1）、术后 30 天（T2）和 180 天（T3）接受 5000IU 视黄醇乙酸酯补充的男性和女性 III 类肥胖个体组成。通过高效液相色谱法对维生素 A 营养状况进行评估，用生化指标（视黄醇和β-胡萝卜素血清水平）进行评估，其不足的截断值分别为<1.05μmol/L 和>或=40μg/dL。
在 114 例评估患者中，平均年龄为 36.9+/-11.6 岁，BMI>或=40kg/m2。VAD 的患病率为 14%，T1 时为 37.5%，T2 时为 50.8%和 67.8%，T3 时为 52.9%和 67%，分别为视黄醇和血清β-胡萝卜素。T1 时，随着 BMI 的增加，视黄醇和β-胡萝卜素血清水平下降。随着视黄醇的增加，发现极低密度脂蛋白胆固醇（VLDLc）和甘油三酯增加，T3 时为 VLDLc，T1 和 T2 时为甘油三酯。T1 时，高密度脂蛋白胆固醇（HDLc）与β-胡萝卜素呈正相关，T3 时与β-胡萝卜素呈负相关。
术前和术后 30 天和 180 天 VAD 的高患病率，甚至在补充期间，所有三个研究时间点β-胡萝卜素的不足率更高，可能是由于需要生物转化为视黄醇，而这是由于这些个体所暴露的需求增加所致。建议口服补充剂的作用没有达到预期效果，强调术前和术后 Roux-en-Y 胃旁路术需要评估维生素 A 的营养状况。T1 时 VAD 的高患病率，T2 和 T3 时的严重程度，证实了<1.05μmol/L 作为研究人群中 VAD 标志物的应用，加强了其在临床实践中作为工具的应用，以识别接受减肥手术的病态肥胖患者的 VAD。
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