Relation Between Carbohydrate Intake and Weight Loss After Bariatric Surgery

Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB)

<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.

Preoperative Carbohydrate Quality Index Is Related to Markers of Glucose Metabolism 12 Months After Roux-en-Y Gastric Bypass

OBJECTIVE

The role of carbohydrates in weight loss in patients undergoing bariatric surgery (BS) remains poorly understood. Therefore, this study aimed to verify the relationship of the carbohydrate quality index (CQI) with weight loss and cardiometabolic risk markers up to 1 year after BS.

MATERIAL AND METHODS

This study included 50 patients with obesity undergoing Roux-en-Y gastric bypass. Data collection was performed preoperatively and 3 and 12 months after surgery. The foods consumed were documented using a 24-h food recall in 3 days. The CQI was calculated considering the following parameters: dietary fiber intake, sugar level; whole grains: proportion of total grains; solid carbohydrate: total carbohydrate ratio.

RESULTS

From the total study sample, 58 participants were followed up for 3 months, and eight participants dropped out of the study. The remaining 50 patients were followed up for 12 months. Subjects were classified into tertiles according to the index score. A 1-unit increase in CQI was associated with a -1.02 decrease in insulin concentrations at 12 months and a -1.04 decrease in HOMA-IR. Concerning the total sample, the median of the CQI was 8 points and did not change at 3 and 12 months after surgery, but there was an improvement in some components of the index.

CONCLUSION

The data suggest that the quality of carbohydrates can interfere with markers of insulin resistance after BS and the quality of carbohydrates is a point to be guided in patients undergoing BS.

Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.

Association Between Energy and Macronutrient Intakes and Weight Change After Bariatric Surgery: a Systematic Review and Meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to summarize the evidence on the associations of energy and macronutrient intakes (carbohydrates, fats, and proteins) with weight loss in adults after sleeve gastrectomy or gastric bypass and to determine whether these dietary characteristics of patients with suboptimal weight loss (SWL) or weight regain differ from those without these experiences.

METHODS

PubMed, Scopus, and Web of Science were searched until December 2021. Twenty-three observational studies were included.

RESULTS

Studies on the association of postoperative energy and macronutrients and weight loss used diverse approaches. Pooled results showed that patients with SWL consumed more energy than those with acceptable weight loss. Weight regainers consumed more energy and carbohydrates and less protein than non-regainers.

CONCLUSIONS

Higher energy consumption is related to SWL and weight regain after surgery. Associations between macronutrients and weight outcome following bariatric surgery warrant further investigation.

Diet and physical activity are associated with suboptimal weight loss and weight regain 10-15 years after Roux-en-Y gastric bypass: A cross-sectional study

INTRODUCTION

Suboptimal weight loss (SWL) after bariatric surgery affects approximately 30% of the patients in the long-term. Diet and physical activity (PA) are likely to modulate long term weight loss outcomes after Roux-en-Y gastric bypass (RYGB).

OBJECTIVES

To compare food habits and PA levels between those experiencing SWL and optimal weight loss (OWL), and between those experiencing weight regain (WR) and no weight regain (NWR), 10-15 years after RYGB, in addition to a pre-operative control group.

METHODS

Participants were recruited from the Bariatric Surgery Observation Study (BAROBS), ≥ 10 y after RYGB. Food intake was assessed by a Food Frequency Questionnaire (FFQ) and PA levels with Sensewear armbands.

RESULTS

75 participants (79% females) were recruited. Excess weight loss (EWL) was 17 ± 19% and 87 ± 22% in the SWL and OWL groups, respectively and WR was 31 ± 15% and 1 ± 11% in the WR and NWR groups, respectively (P < 0.001 for both). The OWL group reported a lower energy intake (P = 0.012) than the control group. The control group reported a higher intake of milk, cream and cheese than both SWL group (P = 0.008) and OWL group (P < 0.001). The SWL group reported a higher intake of processed meat products than the OWL group, while the OWL group reported a lower intake of sauces than both the SWL and the control groups (P < 0.001 and P = 0.005, respectively). The OWL group reported a lower intake of cakes, sugar and sweets than both SWL group (P = 0.035) and control group (P = 0.021). The WR group reported a lower PA duration (P = 0.046) compared with the NWR group. EWL was positively, and WR negatively, correlated with average PA duration.

CONCLUSION

A high intake of energy-dense foods and low PA is associated with poor weight loss outcomes, namely SWL and WR, 10-15 years after RYGB.

Nutritional guidance, monitoring, and supplementation before and after bariatric surgery - Are we doing this correctly?

Introduction

Background and aims: minimizing nutritional depletions after a Roux-en-Y gastric bypass (RYGB) may improve clinical results in the treatment of obesity. We evaluated nutritional aspects of obese women undergoing RYGB at a reference university hospital with a department specialized in bariatric surgery. Method: based on the Dietary Reference Intakes developed by the Food and Nutrition Council, Institute of Medicine, and the guidelines issued by the American Society for Metabolic and Bariatric Surgery, we assessed the quantitative and qualitative adequacy of nutritional intake, supplementation, and biochemical monitoring of 20 women both before and 3 and 12 months after a RYGB. Data on nutritional intake was obtained by applying different food surveys, quantitatively interpreted by the Virtual Nutri Plus® software and using reference nutritional databases. Results: nutritional intake deficits were already found before the RYGB (p ≤ 0.05). These worsened postoperatively (p ≤ 0.05), a period also marked by a qualitatively poor diet. The nutritional supplementation prescribed did not fully achieve the reference recommendations, and was poorly complied with by patients. Furthermore, nutritional monitoring was not carried out in all patients, recommended biochemical markers were not screened, and vitamin D depletions occurred. Conclusion: our data suggest that institutions specialized in bariatric patient care may not be adequately adhering to well known guidelines, or applying efficient strategies to improve compliance.

Reported nutrient intake over 7 years after Roux-en-Y gastric bypass in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) psychosocial study

BACKGROUND

Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss.

OBJECTIVE

Long-term data on postsurgical nutrient intake are lacking.

SETTING

The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study.

METHODS

Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes.

RESULTS

After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142.

CONCLUSIONS

The reduction in energy resulted in intakes below the dietary reference intakes for many micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.

The effects of bariatric surgery on psychological aspects of eating behaviour and food intake in humans

Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1-2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.

Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy

BACKGROUND AND OBJECTIVE

The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy.

MATERIAL AND METHODS

A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out.

RESULTS

A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin.

CONCLUSIONS

Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention.

Baseline Anthropometric and Metabolic Parameters Correlate with Weight Loss in Women 1-Year After Laparoscopic Roux-En-Y Gastric Bypass

BACKGROUND

In this study, we explored in a prospective cohort of morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass (LRYGP) correlations between baseline anthropometrics, metabolic parameters, resting energy expenditure (REE), body composition, and 1-year % excess body mass index loss (%EBMIL). We also investigated risk factors for insufficient %EBMIL.

METHODS

One hundred three consecutive women were prospectively evaluated at baseline (age 40.6 ± 11.2, weight 113.9 kg ± 15.3, BMI 43.3 ± 4.9 kg/m²) and 1 year after LRYGP. Weight, excess weight, brachial circumference, waist circumference, fat mass (FM) and fat-free mass (FFM) (measured with bioelectrical impedance analysis), REE, inflammation, insulin resistance, and lipid disturbances were determined before and 1 year after LRYGP.

RESULTS

At 1 year, mean weight loss was 39.8 kg ± 11.7 and mean EBMIL was 15.2 kg/m² ± 4.2. Mean %EBMIL was 86% ± 21% (range 30-146%). Baseline brachial circumference, waist circumference and triceps skinfold thickness decreased significantly at 1 year (P < 0.001). Blood glucose and insulin levels, HDL cholesterol, LDL cholesterol, triglycerides, and CRP also decreased significantly (P < 0.001). The mean loss of initial FFM and FM was 9.1 kg ± 8.2 (15%) and 30.7 kg ± 11.8 (53%), respectively. REE on body weight ratio (REE/BW) increased from 15.3 kcal/kg ± 2.8 to 18.4 kcal/kg ± 2.5 (p < 0.0001) and REE on FFM ratio decreased from 31.2 to 28.7 kcal/day/kg (p < 0.001). Preoperative waist circumference (r = -0.3; P < 0.001), blood glucose level (r = -0.37; P < 0.001), and CRP (r = -0.28; P = 0.004) were negatively correlated with EBMIL% 1 year after surgery. Among baseline body composition parameters, only preoperative FM was negatively correlated with %EBMIL (r = -0.23; p = 0.02). One year after surgery FM change was negatively correlated with EBMIL% (r = -0.49; P < 0.001) while FFM/BW ratio was positively correlated with %EBMIL (r = 0.71; P < 0.001). Increase in REE/BW at 1 year was positively correlated with %EBMIL (r = 0.47; p < 0.001). On multivariate analysis, baseline blood glucose level (OR = 1.77; CI 95%: [1.3-2.4]) was the only predictive factor of EBMIL <60% at 1 year.

CONCLUSION

LRYGB has beneficial effects on clinical, biological parameters, and body composition. Increasing the proportion of FFM on total BW and REE/BW is associated with better results in terms of weight loss. Baseline glucose level may be helpful in identifying poor responders to LRYGBP.

TRIAL REGISTRATION

NCT02820285y ( https://clinicaltrials.gov/ct2/show/NCT02820285?term=Characterization+of+Immune+Semaphorin+in+Non-Alcoholic+Fatty+Liver+Disease+and+NASH&rank=1 ).

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Background: Approximately 20-30% of obese patients do not achieve successful weight outcomes after bariatric surgery.Objective: We examined whether short-term changes (≤0.5 y postsurgery) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change.Design: Participants were recruited from the Swedish Obese Subjects (SOS) study, which was a matched (nonrandomized) prospective trial that compared bariatric surgery with usual care for obese patients. A total of 2010 patients who underwent bariatric surgery were included in the study. Physical examinations (e.g., weight) and questionnaires (e.g., dietary questionnaire) were completed before and 0.5, 1, 2, 3, 4, 6, 8, and 10 y after surgery. For the main analytic strategy, a linear mixed model was implemented, which included repeated measures with a random intercept and an unstructured covariance matrix.Results: Short-term changes in energy intake (P < 0.001) and in relative proportions of energy from carbohydrates (P < 0.001), fat (P < 0.001), and protein (P < 0.05) were associated with 10-y weight change after bariatric surgery. At the 10-y follow-up, men and women with the largest reductions in energy intake had lost 7.3% and 3.9% more weight, respectively, compared with that of subjects with the smallest intake reductions (P < 0.001). Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition (P < 0.05).Conclusions: The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss. Weight loss is also associated with a changing dietary macronutrient composition. This trial was registered at clinicaltrials.gov as NCT01479452.

Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy

OBJECTIVES

Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG).

METHODS

A retrospective case-control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m(2)), was performed. Patients were grouped according percentile->50% (cases) or <50% (controls)-of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. RESULTS (MEDIAN [P25-P75]): The evaluation was conducted 38.5 mo (34-41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13-37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR (r = 0.673; P = 0.023). Significantly higher body mass index (P = 0.001), resting energy expenditure (P = 0.04), fasting insulin (P = 0.01), and HOMA-IR (P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01).

CONCLUSIONS

Results from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.

Differential effects of Roux-en-Y gastric bypass surgery on brown and beige adipose tissue thermogenesis

BACKGROUND

There are numerous reports of increased energy expenditure after Roux-en-Y gastric bypass (RYGB) surgery in humans and rodent models but the underlying mechanisms remain poorly understood. In the present study we assessed at the gene expression level whether RYGB leads to recruitment of brown adipose tissue (BAT) and/or beige adipose tissue (BeAT) as a means of enhanced facultative thermogenesis and increased energy expenditure after surgery.

METHODS

Diet-induced obese male Wistar rats were randomized into RYGB-operated (n=10), sham-operated ad libitum fed (Sham) (n=7) or sham-operated body weight matched (BWM) to RYGB groups (n=7). At a stage of postoperatively stabilized weight reduction, BAT (interscapular), subcutaneous (inguinal) and visceral (epididymal and perirenal) white adipose tissue (WAT) depots were collected in the fasted state. Expression of thermoregulatory genes (UCP1, CIDEA and PRDM16) in BAT and WAT as well as specific markers of BeAT (Ear2 and TMEM26) in WAT was analyzed using RT-qPCR.

RESULTS

Compared to Sham rats, UCP1 mRNA expression in BAT was significantly reduced in BWM, but not in RYGB rats. No differences in mRNA expression were found for thermoregulatory proteins or for markers of BeAT in subcutaneous or visceral WAT depots between RYGB and Sham groups.

CONCLUSION

The compensatory decrease in BAT thermogenic gene expression typically associated with body weight loss is attenuated after RYGB which, as opposed to recruitment of BeAT, may contribute to overall increases in energy expenditure and weight loss maintenance after surgery.

Comparison of weight loss, food consumption and frequency of vomiting among Roux-en-Y gastric bypass patients with or without constriction ring

BACKGROUND

After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch.

AIM

To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch.

METHOD

A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection.

RESULTS

Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88 ± 17.50 months, and for the No-Ring Group 51 ± 15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%).

CONCLUSION

The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors that have definite influence in the health of the bariatric patient.

Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid

Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.

Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass

OBJECTIVE

The effects of food tolerance (if any) on diet quality several years post-surgery remain unclear. Our study aimed to assess food tolerance and diet quality after three bariatric procedures; adjustable gastric banding (AGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP), 2â??4 years post-surgery.

METHODS

This prospective, cross-sectional study assessed weight loss, food tolerance and diet quality in 130 subjects (14 obese pre-surgical controls, 13 AGB, 62 SG and 41 RYGBP). Inclusion criteria selected patients who underwent bariatric surgery between 1 January 2007 and 31 December 2008, at a single bariatric clinic. Non-parametric tests (Kruksalâ??Wallis and Mannâ??Whitney) along with Spearman's correlation coefficient analysis were used.

RESULTS

Superior food tolerance was reported by the control (24.5), SG (24.0) and RYGBP (22.0) groups, compared with the AGB group (15.5; P < 0.001). The control and AGB groups consumed significantly more high-calorie extra foods (9.2 and 7.7 daily serves respectively) compared with the SG (3.4 serves) and RYGBP (4.0 serves) groups. There were several significant correlations between food tolerance and dietary intake including breads and cereals and meat and meat alternatives.

CONCLUSION

The control and AGB groups consumed significantly more high-calorie extra foods, a result that was paralleled by poor weight loss and food tolerance outcomes for the AGB group. A significant positive relationship between food tolerance and diet quality was established. Poor food tolerance and thus compromised diet quality need to be considered as post-surgical complications of the AGB procedure.

Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2-10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.

Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial

OBJECTIVES

Increased energy expenditure (EE) has been proposed as an important mechanism for weight loss following Roux-en-Y gastric bypass (RYGB). However, this has never been investigated in a controlled setting independent of changes in energy balance. Similarly, only few studies have investigated the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control and specific signalling molecules compared with a control group in comparable negative energy balance.

SUBJECTS/METHODS

Obese normal glucose-tolerant participants were randomized to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (weeks 7, 11 and 78) where 24-h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from weeks 0-11, with those operated at week 12 serving as a control group for those operated at week 8.

RESULTS

Compared with controls, RYGB-operated participants had lower body composition-adjusted 24-h EE and basal EE 3 weeks postoperatively (both P<0.05) but EE parameters at week 78 were not different from preoperative values (week 7). Surgery changed the postprandial response of glucagon-like peptide-1 (GLP-1), peptide YY3-36 (PYY), ghrelin, cholecystokinin, fibroblast growth factor-19 and bile acids (all P<0.05). Particularly, increases in GLP-1, PYY and decreases in ghrelin were associated with decreased appetite. None of HOMA-IR (homeostasis model assessment-estimated insulin resistance), Matsuda index, the insulinogenic index, the disposition index and fasting hepatic insulin clearance were different between the groups, but RYGB operated had lower fasting glucose (P<0.05) and the postprandial glucose profile was shifted to the left (P<0.01).

CONCLUSIONS

Our data do not support that EE is increased after RYGB. More likely, RYGB promotes weight loss by reducing appetite, partly mediated by changes in gastrointestinal hormone secretion. Furthermore, we found that the early changes in glycaemic control after RYGB is to a large extent mediated by caloric restriction.

Surgical weight loss: impact on energy expenditure

Diet-induced weight loss is often limited in its magnitude and often of short duration, followed by weight regain. On the contrary, bariatric surgery now commonly used in the treatment of severe obesity favors large and sustained weight loss, with resolution or improvement of most obesity-associated comorbidities. The mechanisms of sustained weight loss are not well understood. Whether changes in the various components of energy expenditure favor weight maintenance after bariatric surgery is unclear. While the impact of diet-induced weight loss on energy expenditure has been widely studied and reviewed, the impact of bariatric surgery on total energy expenditure, resting energy expenditure, and diet-induced thermogenesis remains unclear. Here, we review data on energy expenditure after bariatric surgery from animal and human studies. Bariatric surgery results in decreased total energy expenditure, mainly due to reduced resting energy expenditure and explained by a decreased in both fat-free mass and fat mass. Limited data suggest increased diet-induced thermogenesis after gastric bypass, a surgery that results in gut anatomical changes and modified the digestion processes. Physical activity and sustained intakes of dietary protein may be the best strategies available to increase non-resting and then total energy expenditure, as well as to prevent the decline in lean mass and resting energy expenditure.

Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population

BACKGROUND

Data on long-term dietary changes and nutritional deficiencies after sleeve gastrectomy (SG) in grade 3 obese patients are scarce.

OBJECTIVE

To prospectively compare dietary changes and nutritional deficiencies in grade 3 obese patients 5 years after SG and Roux-en-y gastric bypass (GBP).

PARTICIPANTS/SETTING

Three hundred and fifty-five patients who had SG (n=61) or GBP (n=294) (May 2001-December 2006) at a Spanish university hospital.

DESIGN

Longitudinal, prospective, observational study. PRIMARY OUTCOMES/STATISTICAL ANALYSES: Changes in energy, macronutrient, and micronutrient intake, and weight loss were analyzed using mixed models for repeated measurements.

RESULTS

At the 5-year follow-up visit, the percentage of excess weight loss (P=0.420) and daily energy intake (P=0.826), as well as the proportion of energy from carbohydrates (P=0.303), protein (P=0.600), and fat (P=0.541) did not differ between surgical groups. Energy intake (P=0.004), baseline weight (P<0.001), and time period (P<0.001), but not the proportion of different macronutrients or the type of surgery, independently predicted the percentage excess weight loss over time. After SG or GBP, the mean daily dietary intake of calcium, magnesium, phosphorus, and iron was less than the current recommendations. Despite universal supplementation, the prevalence of nutritional deficiencies was comparable after SG or GBP, with 25-hydroxyvitamin D being the most commonly observed deficiency (SG, 93.3% to 100%; GBP, 90.9% to 85.7%, P=not significant). In an adjusted multivariate regression model, energy intake and lipid intake independently predicted plasma 25(OH)-vitamin D levels.

CONCLUSIONS

Data show that SG and GBP are associated with similar long-term weight loss with no differences in terms of dietary intake. Furthermore, data demonstrate that both types of surgeries carry comparable nutritional consequences.

Dietary protein intake and bariatric surgery patients: a review

Bariatric surgery, a highly successful treatment for obesity, requires adherence to special dietary recommendations to insure the achievement of weight loss goals and weight maintenance. Postoperative consumption of protein is linked to satiety induction, nutritional status, and weight loss. Hence, we conducted an extensive literature review to identify studies focused on the following: protein and nutritional status; recommendations for dietary protein intake; the effects of protein-rich diets; and associations between dietary protein intake and satiety, weight loss, and body composition. We found that there have been few studies on protein intake recommendations for bariatric patients. Dietary protein ingestion among this population tends to be inadequate, potentially leading to a loss of lean body mass, reduced metabolic rates, and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhanced weight loss, and improved body composition. The quality and composition of protein sources are also very important, particularly with respect to the quantity of leucine, which helps to maintain muscle mass, and thus is particularly important for this patient group. Randomized studies among bariatric surgery patient populations are necessary to establish the exact quantity of protein that should be prescribed to maintain their nutritional status.

Psychiatric disorders and participation in pre- and postoperative counselling groups in bariatric surgery patients

BACKGROUND

Psychological and behavioural factors seem to influence the results of bariatric surgery and the ability to achieve sustained weight loss and subjective wellbeing after the operation. Adequate pre- and postoperative psychological counselling are suggested to improve the results of surgery. However, some patients are reluctant to participate in pre- and postoperative counselling. The aim of the present study was to investigate the possible influence of psychiatric disorders on willingness to participate in group counselling in patients accepted for bariatric surgery.

METHODS

One hundred and forty-one patients referred to bariatric surgery (F/M: 103/38) with mean body mass index (BMI) of 45.2 kg/m2 (SD = 5.3) and mean age of 42.0 years (SD = 10.4) were interviewed with Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II) preoperatively.

RESULTS

The overall prevalence of current psychiatric disorders was 49%. Thirty-one percent did not want to participate in counselling groups. Patients who were unwilling to participate in counselling groups had significantly higher prevalence of social phobia (32%/ 12%, p = 0.006) and avoidant personality disorder (27%/ 12%, p = 0.029) than patients who agreed to participate.

CONCLUSIONS

Psychiatric disorders are prevalent among candidates for bariatric surgery. Social phobia and avoidant personality disorder seem to influence the willingness to participate in counselling groups. Individual counselling and/or web-based counselling might be recommended for bariatric surgery patients who are reluctant to participate in group counselling.

Nutritional pyramid for post-gastric bypass patients

BACKGROUND

Life-long nutrition education and diet evaluation are key to the long-term success of surgical treatment of obesity. Diet guidelines provided for bariatric surgery patients generally focus on a progression through dietary stages, from the immediate post-surgical period to 6 months after surgery. However, long-term dietary guidelines for those surgically treated for obesity are not readily available. Therefore, there is a need for dietary recommendations for meal planning and nutritional supplementation for bariatric surgery patients beyond the short-term, post-operative period. The purpose of this paper is to construct an educational tool to provide long-term nutritional and behavioral advice for the post-bariatric patient.

METHODS

The manuscript summarizes the current knowledge on dietary strategies and behaviors associated with beneficial nutritional outcomes in the long term of post-bariatric surgery patients.

RESULTS

Dietary and nutritional recommendations are presented in the form of a "bariatric food pyramid" designed to be easily disseminated to patients.

CONCLUSIONS

The development of educational tools that are easy to understand and follow is essential for effective patient management during the surgery follow-up period. The pyramid can be used as a tool to help both therapists and patients to understand nutrition recommendations and thus promote a healthy long-term post-op dietary pattern based on high-quality protein, balanced with nutrient-dense complex carbohydrates and healthy sources of essential fatty acids.