JOEL FAINTUCH
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Abnormalities of Reproductive Function in Male Obesity Before and After Bariatric Surgery-A Comprehensive Review(2015) ROSENBLATT, Alberto; FAINTUCH, Joel; CECCONELLO, IvanYoung males represent one of the populations with the steepest increases in the incidence of obesity. They are also prone to significant derangements in sexual health and fertility. Despite a growing number of reports about female reproductive health, in the setting of bariatric surgery, males have received much less attention. In the current review of reproductive abnormalities in severe obese males before and after bariatric surgery, erectile function, hypothalamic-pituitary-gonadal axis status, sex hormones, semen quality, fertility and assisted reproductive techniques, along with analysis of adipokines, gut hormones, and environmental factors are addressed. Available evidence about weight loss benefits, both medical and surgical, are highlighted, along with perspectives for future investigations, which may be relevant for the patient, for the couple, and for the community alike.
- High Frequency of Serum Chromium Deficiency and Association of Chromium with Triglyceride and Cholesterol Concentrations in Patients Awaiting Bariatric Surgery(2014) LIMA, Karla V. G.; LIMA, Raquel P. A.; GONCALVES, Maria C. R.; FAINTUCH, Joel; MORAIS, Liana C. S. L.; ASCIUTTI, Luiza S. R.; COSTA, Maria J. C.Background To our knowledge, the frequency of serum chromium deficiency in patients awaiting bariatric surgery has not been determined. This study was designed to assess chromium concentration and its association with glycemic levels and lipid profile in patients prior to bariatric surgery. Methods This study recruited 73 candidates for bariatric surgery between March and September 2012. Their sociodemographic, anthropometric, and biochemical data were collected. Results Of the 73 patients, 55 (75.3 %) were women (75.34 %). Mean patient age was 37.20 +/- 9.92 years, and mean body mass index was 47.48 kg/m(2) (range, 43.59 to 52.50 kg/m(2)). Chromium deficiency was observed in 64 patients (87.7 %). Correlation analysis showed significant negative relationships between chromium concentration and BMI and zinc concentration and a significant positive relationship between chromium and glycated hemoglobin. Multiple linear regression analysis showed that serum chromium concentration was significantly associated with total cholesterol (beta = 0.171, p = 0.048) and triglyceride (beta = -0.181, p = 0.039) concentrations. Conclusions Serum chromium deficiency is frequent in candidates for bariatric surgery and is associated with total cholesterol and triglyceride concentrations. Early nutritional interventions are needed to reduce nutritional deficiencies and improve the lipid profile of these patients.
- Magnesium Deficiency and Gastric Bypass(2011) FAINTUCH, Joel
- Does Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?(2013) HAYASHI, Silvia Y.; FAINTUCH, Joel; YAGI, Osmar K.; YAMAGUCHI, Camila M.; FAINTUCH, Jacob J.; CECCONELLO, IvanCancer gastrectomy seems to benefit type 2 diabetes; however, results are conflicting. In a prospective protocol, including retrospective information, the aim was assessment of changes in glucose profile in patients with both normal and deranged preoperative glucose homeostasis. Patients (N = 164) with curative subtotal or total Roux-en-Y gastrectomy for gastric cancer (n = 92), or Roux-en-Y gastric bypass for morbid obesity (RYGB, n = 72) were preoperatively classified into diabetes (including prediabetes) and control group. Postoperative diabetes outcome was stratified as responsive or refractory, and results in controls were correspondingly defined as stable or new-onset diabetes (NOD), according to fasting blood glucose and HbA1c. Dietary intake and biochemical profile was documented. Statistical methods included analysis of variance, multivariate logistic regression, and propensity score matching according to postoperative weight loss. Age of cancer cases was 67.9 +/- A 11.5 years, 56.5 % males, initial body mass index (BMI) 24.7 +/- A 3.7, current BMI 22.6 +/- A 3.8 kg/m(2), and follow-up 102.1 +/- 51.0 months, whereas in bariatric individuals age was 51.4 +/- A 10.1 years, 15.3 % males, initial BMI 56.7 +/- A 12.2, current BMI 34.8 +/- A 8.1 kg/m(2), and follow-up 104.1 +/- 29.7 months. Refractory disease corresponded to 62.5 % (cancer) versus 23.5 % (bariatric) (P = 0.019), whereas NOD represented 69.2 versus 23.8 % respectively (P = 0.016). Weight loss (Delta BMI) was associated with diabetes response in cancer patients but not with NOD. No difference between subtotal and total gastrectomy was detected. Divergent outcomes (refractory vs. responsive) were confirmed in BMI-similar, propensity-matched cancer gastrectomy patients with preoperative diabetes, consistent with weight-dependent and -independent benefits. Diabetes response was confirmed, however with more refractory cases than in bariatric controls, whereas high proportions of NOD occurred. Such dichotomous pattern seems unusual albeit consistent with previous studies.
- Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients(2017) OLIVEIRA, Patricia Amante de; KOVACS, Cristiane; MOREIRA, Priscila; MAGNONI, Daniel; SALEH, Mohamed Hassan; FAINTUCH, JoelSeveral studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
- Epithelial Cell Turnover Is Increased in the Excluded Stomach Mucosa After Roux-en-Y Gastric Bypass for Morbid Obesity(2013) SAFATLE-RIBEIRO, Adriana V.; PETERSEN, Pedro A.; PEREIRA FILHO, Dilson S.; CORBETT, Carlos E. P.; FAINTUCH, Joel; ISHIDA, Robson; SAKAI, Paulo; CECCONELLO, Ivan; RIBEIRO JR., UlyssesMucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach. Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 mu m thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method. The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7 %, antrum = 24.9 %) was significantly higher compared to controls (body = 15.0 % and antrum = 17.7 %), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31 %), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases. Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.
- Asymptomatic Gastric Bacterial Overgrowth After Bariatric Surgery: Are Long-Term Metabolic Consequences Possible?(2014) ISHIDA, Robson K.; FAINTUCH, Joel; RIBEIRO, Adriana Safatle; RIBEIRO JR., Ulysses; CECCONELLO, IvanPatients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 years. It was hypothesized that systemic associations analogous to those reported for whole gut microbiome would be revealed. Patients (n = 37, 70.3 % females, 42.4 +/- 9.9 years old, preoperative BMI 53.5 +/- 10.6 kg/m(2), current BMI 32.8 +/- 10.8 kg/m(2)), all submitted to RYGB on account of morbid obesity, were followed during 176.8 +/- 25.7 months. Blood tests included fasting blood glucose, HbA1c, liver and pancreatic enzymes, and lipid fractions. Bacterial overgrowth was diagnosed by quantitative culture of gastric fluid in both the excluded remnant and the gastric pouch, with the help of double-balloon enteroscopy. Absolute counts of aerobes and anaerobes in both gastric reservoirs were correlated with nutritional and biochemical measurements, aiming to identify clinically meaningful associations. Patients denied diarrhea, abdominal pain, weight loss, or other symptoms related to bacterial overgrowth. Biochemical profile including enzymes was also acceptable, indicating a stable condition. Positive correlation of bacterial count in either segment of the stomach was demonstrated for BMI and gamma-glutamyl transferase, whereas negative correlation occurred regarding fasting blood glucose. An antidiabetic role along with deleterious consequences for weight loss and liver function are possible in such circumstances. Such phenotype is broadly consistent with reported effects for the whole gut microbiome. Prospective controlled studies including molecular analysis of gastrointestinal fluid, and simultaneous profiling of the entire microbiome, are necessary to shed more light on these findings.
- Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity(2012) YAMAGUCHI, Camila M.; FAINTUCH, Joel; HAYASHI, Silvia Y.; FAINTUCH, Jacob J.; CECCONELLO, IvanFew studies about long-term glucose homeostasis in bariatric patients are available. In a prospective protocol that included retrospective information, outcome of patients with both impaired and normal fasting blood glucose (FBG) was monitored to assess frequencies and correlates. Patients submitted to Roux-en-Y gastric bypass were classified as group I, elevated FBG, and group II, normal controls. Those in group I with improvement in FBG were defined as responsive and the others as refractory. Group II participants progressing to new-onset diabetes (NOD) or prediabetes represented NOD cases; the remaining were listed as stable controls. FBG was the main endpoint, but HbA1c results were considered, along with diet composition and general biochemical profile. Among 97 selected patients, 51 belonged to group I (52.4 +/- A 10.5 years, 29.6 % males, initial body mass index (BMI) 58.4 +/- A 13.4, current BMI 35.1 +/- A 8.4 kg/m(2)) and 46 to group II (48.2 +/- A 10.5 years, 19.6 % males, initial BMI 55.5 +/- A 8.8, current BMI 33.9 +/- A 6.9 kg/m(2)). Follow-up was 7-9 years, and 31.4 % (16/51) of group I were classified as refractory, whereas 15.2 % (7/46) of the controls converted to NOD. Multivariate analysis pointed out higher current BMI, older age, consumption of antidiabetic drugs, and male gender as features of refractory cases, whereas NOD participants were not significantly different from non-progressing controls. This is the first investigation, to the best of our knowledge, to underscore the correlates of refractory and NOD within the bariatric context. Further studies are recommended as such information could be valuable for patient selection, prognostic scoring, and outcome monitoring.
- Four-Year Hospital Resource Utilization After Bariatric Surgery: Comparison with Clinical and Surgical Controls(2011) HAYASHI, Silvia Yoko; FAINTUCH, Joel; FRANCA, Joao Italo Dias; CECCONELLO, IvanConsumption of healthcare has been shown to diminish after bariatric treatment, but utilization of hospital services has not been well documented. Aiming to assess this question, a retrospective study with females was designed. Yearly outpatient appointments, hospital admissions, emergency department visits, and total biochemical tests during 4 years were registered and compared with the preoperative year. Population (N = 176, all females) comprised 94 bariatric candidates submitted to Roux-en-Y gastric bypass (RYGB; age 41.4 +/- 10.1 years, BMI 52.2 +/- 10.6 kg/m(2)), 34 nonoperated obese controls (age 49.4 +/- 8.3 years, BMI 33.8 +/- 5.5 kg/m(2)), and 48 colorectal surgical controls (age 44.8 +/- 8.6 years, BMI 23.8 +/- 4.7 kg/m(2)). Nonbariatric obese patients were fairly well-matched, moderate differences involving higher age and comorbidities. Surgical controls were similarly aged but suffered from less comorbidities. Obese nonsurgical participants displayed the highest demand for outpatient visits (10.5 +/- 0.9/year, P < 0.001) followed by bariatric and colorectal cases (5.7 +/- 0.2 and 3.5 +/- 0.8, respectively, P = 0.042). Also biochemical measurements were most often required by clinical controls (61.5 +/- 5.1/year, P < 0.001), whereas no difference was detected between bariatric and colorectal patients (28.9 +/- 2.2 and 33.8 +/- 7.7/year, respectively). Elective and emergency admissions were similar for all groups, and part of the postbariatric assistance was related to plastic surgery. RYGB patients needed 45.8% less outpatient visits and 53.0% less laboratory tests than nonoperated moderately obese cases, even including esthetic operations. Results were comparable to those observed after elective colorectal surgery and remained fairly stable during 4 years.
- Is Intake of Vitamin D and Calcium Important for Cardiovascular Health in Elderly Obese Patients?(2012) SOARES, Patricia A. O.; KOVACS, Cristiane; MOREIRA, Priscila; SALEH, Mohamed H.; MAGNONI, Daniel; FAINTUCH, JoelThere is compelling evidence that bariatric weight loss reduces cardiovascular complications; however, these still tend to be the most common cause of late death after surgical intervention. In a prospective cohort study, correlations of dietary nutrients with indexes of vascular health were sought, with emphasis on vitamin D and calcium. Clinically stable obese outpatient subjects (> 60 years old, N = 44) were interviewed about dietary macro and micronutrients. Nutritional assessment targeted anthropometric and bioimpedance analysis (BIA), hematologic counts, lipid profile, glucose homeostasis, and inflammatory markers. Carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD), along with related vascular measurements, were documented, and results were correlated by uni- and multivariate analysis, corrected for known risk factors. IMT, FMD, and also brachial basal flow were positively influenced by vitamin D (P < 0.001). Calcium appeared beneficial for brachial basal flow only (P = 0.010). No association with IMT occurred, and a negative result for FMD was elicited. Also, vitamins A and B12 were advantageous for FMD, whereas iron was deleterious for IMT. Intake of many micronutrients including calcium and vitamin D did not meet recommendations. Vitamin D displayed a beneficial profile regarding vascular health, and more attention to this nutrient should be given, especially concerning obese patients with cardiometabolic risk. Calcium exhibited less straightforward results but deserves focus as well, along with antioxidant vitamin A as well as the B-complex which were mostly deficient in this experience.