1
|
Kokura Y, Ueshima J, Saino Y, Keisuke M. Enhanced protein intake on maintaining muscle mass, strength, and physical function in adults with overweight/obesity: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 63:417-426. [PMID: 39002131 DOI: 10.1016/j.clnesp.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND & AIMS Weight loss in individuals with obesity and overweight leads to metabolic and health benefits but also poses the risk of muscle mass reduction. This systematic review and meta-analysis of randomized controlled trials aims to determine the initial protein amount necessary for achieving weight loss while maintaining muscle mass, strength, and physical function in adults with overweight and obesity. METHODS Relevant literature databases, including Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica (Embase), the Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Web of Science, were electronically searched up to 15 March 2023. We examined the effect of additional protein intake on muscle mass, strength, and physical function in adults with overweight or obesity targeting weight loss. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Results were synthesized using standardized mean differences (SMD) and 95% confidence intervals (CI) via a random-effects model. RESULTS Forty-seven studies (n = 3218) were included. In the muscle mass analysis, twenty-eight trials with 1989 participants were encompassed. Results indicated that increased protein intake significantly prevents muscle mass decline in adults with overweight or obesity aiming for weight loss (SMD 0.75; 95% CI 0.41 to 1.10; p < 0.001). Enhanced protein intake did not significantly prevent decreases in muscle strength and physical function. An intake exceeding 1.3 g/kg/day is anticipated to increase muscle mass, while an intake below 1.0 g/kg/day is associated with a higher risk of muscle mass decline. The risk of bias in studies regarding muscle mass ranged from low to high. CONCLUSIONS Adults with overweight or obesity and aim for weight loss can more effectively retain muscle mass through higher protein intake, as opposed to no protein intake enhancement.
Collapse
Affiliation(s)
- Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, Ishikawa, Japan.
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, Japan, Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Maeda Keisuke
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Aichi, Japan, Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan.
| |
Collapse
|
2
|
Ibacache-Saavedra P, Martínez-Rosales E, Jerez-Mayorga D, Miranda-Fuentes C, Artero EG, Cano-Cappellacci M. Effects of bariatric surgery on muscle strength and quality: A systematic review and meta-analysis. Obes Rev 2024:e13790. [PMID: 38859617 DOI: 10.1111/obr.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/06/2024] [Accepted: 05/20/2024] [Indexed: 06/12/2024]
Abstract
Obesity is a major health burden worldwide. Although bariatric surgery (BS) is recognized as an effective strategy for weight loss and comorbidities improvement, its impact on muscle strength and quality is still unclear. We aimed to examine postoperative changes in muscle strength and quality and their relationship with body mass index (BMI) changes among adults undergoing BS. To this end, we systematically searched the WoS, PubMed, EBSCO, and Scopus databases. The meta-analyses, which included 24 articles (666 participants), showed that BS reduces absolute lower-limb isometric strength (ES = -0.599; 95% CI = -0.972, -0.226; p = 0.002). Subjects who experienced a more significant reduction in BMI after BS also suffered a higher loss of absolute muscle strength. Similarly, absolute handgrip strength showed a significant decrease (ES = -0.376; 95% CI = -0.630, -0.121; p = 0.004). We found insufficient studies investigating medium- and long-term changes in muscle strength and/or quality after BS. This study provides moderate-quality evidence that BS-induced weight loss can reduce the strength of appendicular muscles in the short term, which should be addressed in management these subjects. More high-quality studies are needed to evaluate the impact of BS on muscle strength and the different domains of muscle quality in the medium and long term (registered on PROSPERO CRD42022332581).
Collapse
Affiliation(s)
- Paulina Ibacache-Saavedra
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Elena Martínez-Rosales
- Department of Education & SPORT Research Group (CTS-1024), CIBIS Research Center, University of Almería, Almería, Spain
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Claudia Miranda-Fuentes
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Enrique G Artero
- Department of Education & SPORT Research Group (CTS-1024), CIBIS Research Center, University of Almería, Almería, Spain
| | | |
Collapse
|
3
|
Zhan D, Long Z, Yang H, Wang H, He C, Yin J, Yu J, Fu L, Liu Y. Protein Supplements with Short Peptides Are Better than Complex Protein-Based Supplements on Improving Early Fat-Free Mass Loss Following Bariatric Surgery: A Retrospective Cohort Study. Obes Surg 2024; 34:1608-1617. [PMID: 38530552 DOI: 10.1007/s11695-024-07157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Bariatric surgery (BS) patients are advised to consume protein supplements to prevent fat-free mass (FFM) loss. However, limited research has explored the efficacy of diverse protein presentations on FFM preservation. This study assesses if short peptide-based (SPB) supplements surpass complex protein-based (CPB) supplements in reducing early FFM loss post-surgery. METHODS In this retrospective cohort study, 138 patients who underwent BS other than Roux-en-Y-gastric bypass (RYGB) between January 2021 and March 2021 at the Department of Bariatric Surgery of the Third People's Hospital of Chengdu were included for analysis. Patients were divided into two groups based on their consumption of protein supplements after surgery: SPB group and CPB group. Multiple linear regressions separated by sex were employed to examine the associations between SPB supplements and FFM loss and percentage of FFM (%FFM) loss, respectively. RESULTS Among participants, 69.6% were female, with a mean age of 33.3 years. In multiple linear regression analyses, SPB supplements were significantly and positively associated with a lower FFM loss in both female (ꞵ = - 1.14, P = 0.047) and male (ꞵ = - 2.36, P = 0.024), and were positively associated with a lower %FFM loss in both female (ꞵ = - 1.83) and male (ꞵ = - 2.26) but only significant in male (P = 0.049). CONCLUSION SPB supplements may be more effective in preventing early FFM loss after BS, compared to CPB supplements, particularly among male patients. Therefore, SPB supplements may be recommended to patients undergoing BS. Further research is needed to validate these findings.
Collapse
Affiliation(s)
- Dafang Zhan
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhiwen Long
- Recovery Plus Clinic, Chengdu, 610095, China
| | - Huawu Yang
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | - Han Wang
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | | | - Jun Yin
- Recovery Plus Clinic, Chengdu, 610095, China
| | - Jiahui Yu
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | - Luo Fu
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China
| | - Yanjun Liu
- The Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China.
| |
Collapse
|
4
|
Golzarand M, Toolabi K, Mirmiran P. The effects of protein intake higher than the recommended value on body composition changes after bariatric surgery: A meta-analysis of randomized controlled trials. Clin Nutr 2024; 43:708-718. [PMID: 38320462 DOI: 10.1016/j.clnu.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery. METHODS Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data. RESULTS Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: -9.41 to -0.49) and FM loss by 7.64 kg (95 % CI: -14.01 to -1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: -7.80 kg; 95 % CI: -14.50 to -1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02). CONCLUSION The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG.
Collapse
Affiliation(s)
- Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Karamollah Toolabi
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Farkas GJ, Berg AS, Sneij A, Dolbow DR, Gorgey AS, Gater DR. The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury. Br J Nutr 2024; 131:489-499. [PMID: 37726106 PMCID: PMC10843126 DOI: 10.1017/s0007114523002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
In chronic spinal cord injury (SCI), individuals experience dietary inadequacies complicated by an understudied research area. Our objectives were to assess (1) the agreement between methods of estimating energy requirement (EER) and estimated energy intake (EEI) and (2) whether dietary protein intake met SCI-specific protein guidelines. Persons with chronic SCI (n = 43) completed 3-day food records to assess EEI and dietary protein intake. EER was determined with the Long and Institute of Medicine (IOM) methods and the SCI-specific Farkas method. Protein requirements were calculated as 0·8-1·0 g/kg of body weight (BW)/d. Reporting accuracy and bias were calculated and correlated to body composition. Compared with IOM and Long methods (P < 0·05), the SCI-specific method did not overestimate the EEI (P = 0·200). Reporting accuracy and bias were best for SCI-specific (98·9 %, -1·12 %) compared with Long (94·8 %, -5·24 %) and IOM (64·1 %, -35·4 %) methods. BW (r = -0·403), BMI (r = -0·323) and total fat mass (r = -0·346) correlated with the IOM reporting bias (all, P < 0·05). BW correlated with the SCI-specific and Long reporting bias (r = -0·313, P = 0·041). Seven (16 %) participants met BW-specific protein guidelines. The regression of dietary protein intake on BW demonstrated no association between the variables (β = 0·067, P = 0·730). In contrast, for every 1 kg increase in BW, the delta between total and required protein intake decreased by 0·833 g (P = 0·0001). The SCI-specific method for EER had the best agreement with the EEI. Protein intake decreased with increasing BW, contrary to protein requirements for chronic SCI.
Collapse
Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arthur S. Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David R. Dolbow
- Department of Physical Therapy, William Carey University, Hattiesburg, MS, USA
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Taselaar AE, Boes AJ, de Bruin RWF, Kuijper TM, Van Lancker K, van der Harst E, Klaassen RA. PROMISE: effect of protein supplementation on fat-free mass preservation after bariatric surgery, a randomized double-blind placebo-controlled trial. Trials 2023; 24:717. [PMID: 37946272 PMCID: PMC10636856 DOI: 10.1186/s13063-023-07654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/13/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Protein malnutrition after bariatric surgery is a severe complication and leads to significant morbidity. Previous studies have shown that protein intake and physical activity are the most important factors in the preservation of fat-free mass during weight loss. Low protein intake is very common in patients undergoing bariatric surgery despite dietary counseling. Protein powder supplements might help patients to achieve the protein intake recommendations after bariatric surgery and could therefore contribute to preserve fat-free mass. This double-blind randomized placebo-controlled intervention study aims to assess the effect of a daily consumed clear protein powder shake during the first 6 months after bariatric surgery on fat-free mass loss in the first 12 months after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS AND ANALYSIS Inclusion will take place at the outpatient clinic of the bariatric expertise center for obesity of the Maasstad Hospital. Patients will be randomly assigned to either the intervention or control group before surgery. The intervention group will receive a clear protein powder shake of 200 ml containing 20 g of whey protein dissolved in water which should be taken daily during the first 6 months after LRYGB on top of their normal postoperative diet. The control group will receive an isocaloric, clear, placebo shake containing maltodextrine. Postoperative rehabilitation and physiotherapeutical guidance will be standardized and similar in both groups. Also, both groups will receive the same dietary advice from specialized dieticians. The main study parameter is the percentage of fat-free mass loss 6 months after surgery, assessed by multi-frequency bioelectrical impedance analysis (MF-BIA). ETHICS AND DISSEMINATION The protocol, version 2 (February 20, 2022) has been approved by the Medical Research Ethics Committees United (MEC-U) (NL 80414.100.22). The results of this study will be submitted to peer-reviewed journals. TRIAL REGISTRATION ClinicalTrials.gov NCT05570474. Registered on October 5, 2022.
Collapse
Affiliation(s)
- A E Taselaar
- Maasstad Ziekenhuis Rotterdam, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands.
| | - A J Boes
- Maasstad Ziekenhuis Rotterdam, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands
| | - R W F de Bruin
- Department of Surgery, Erasmus MC, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - T M Kuijper
- Maasstad Academy, Maasstad Hospital, Rotterdam, Netherlands
| | - K Van Lancker
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - E van der Harst
- Maasstad Ziekenhuis Rotterdam, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands
| | - R A Klaassen
- Maasstad Ziekenhuis Rotterdam, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands
| |
Collapse
|
7
|
Jung HN, Kim SO, Jung CH, Lee WJ, Kim MJ, Cho YK. Preserved Muscle Strength Despite Muscle Mass Loss After Bariatric Metabolic Surgery: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3422-3430. [PMID: 37728838 PMCID: PMC10602996 DOI: 10.1007/s11695-023-06796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Contrary to the previously known concept of muscle mass decrease following bariatric metabolic surgery, changes in muscle strength have been poorly investigated in systematic reviews. In this meta-analysis, we evaluated changes in handgrip strength (HGS) and lean mass (LM) after undergoing bariatric metabolic surgery. METHODS A systematic literature review using the PubMed, Embase, and Cochrane Library databases was conducted in November 2022. Longitudinal studies reporting HGS change after bariatric metabolic surgery were eligible. Pooled estimates for changes in HGS, body mass index (BMI), LM, and fat mass (FM) were calculated. Changes from baseline to the point closest to 6 months postoperatively were analyzed in trials with multiple follow-up examinations. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist. RESULTS Three randomized controlled trials and seven prospective cohort studies involving 301 patients were included. Follow-up evaluations were conducted 6 months postoperatively in all trials except for two, whose follow-up visits were at 18 weeks and 12 months, respectively. Pooled analysis showed reduced BMI (- 10.8 kg/m2; 95% confidence interval: - 11.6 to - 9.9 kg/m2), LM (- 7.4 kg; - 9.3 to - 5.4 kg), and FM (- 22.3 kg; - 25.1 to - 19.6 kg) after bariatric metabolic surgery, whereas the change in HGS was not statistically significant (- 0.46 kg; - 1.76 to 0.84 kg). CONCLUSION Despite the decreased body composition parameters, including muscle mass, strength was not impaired after bariatric metabolic surgery; this indicates that bariatric metabolic surgery is an effective weight management intervention that does not compromise strength.
Collapse
Affiliation(s)
- Han Na Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-Ro 170Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do, 14068, Republic of Korea
| | - Seon-Ok Kim
- Department of Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Chang Hee Jung
- Asan Diabetes Center, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Woo Je Lee
- Asan Diabetes Center, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Myung Jin Kim
- Asan Diabetes Center, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yun Kyung Cho
- Asan Diabetes Center, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
8
|
Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
Collapse
Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
| |
Collapse
|
9
|
Nuijten MAH, Eijsvogels TMH, Sanders B, Vriese LM, Monpellier VM, Hazebroek EJ, Janssen IMC, Hopman MTE. Changes in Fat-Free Mass, Protein Intake and Habitual Physical Activity Following Roux-en-Y Gastric Bypass Surgery: A Prospective Study. Obes Surg 2023; 33:2148-2157. [PMID: 37249699 PMCID: PMC10228447 DOI: 10.1007/s11695-023-06650-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Large inter-individual variations in post-bariatric fat-free mass loss (FFML) are observed, which might relate to differences in protein intake and physical activity across patients. We performed repetitive assessments of protein intake and physical activity before and after banded Roux-en-Y gastric bypass surgery, and examined its relations to FFML during 6 months of follow-up. MATERIALS AND METHODS FFML (bio-impedance analyses), protein intake (24-h dietary recalls) and moderate-to-vigorous physical activity (MVPA; activPAL) were assessed in 28 patients (4 males, age 42 ± 12 years) before surgery and at 1-, 3- and 6-months post-surgery. Changes in protein intake and MVPA were evaluated with mixed model analysis, whereas associations with FFML were assessed by univariate regression analysis. RESULTS Six-month FFML was -7.3 ± 3.6 kg. Protein intake decreased from 80 ± 29 g/day (pre-surgery) to 45 ± 26 g/day (1 month post-surgery (P < 0.001)) and did not improve thereafter (51 ± 21 g/day; P > 0.05). Seven participants (25%) consumed ≥ 60 g protein/day at 6 months post-surgery. Participants performed 7394 ± 2420 steps/day in 54 ± 20 min/day of MVPA, which did not change from pre- to post-surgery (P > 0.05). A higher step count (B = -0.002; 95%CI = [-0.004 - 0.000]; P = 0.048) and higher level of MVPA (B = -0.29; 95%CI = [-0.54 - -0.03]; P = 0.018) were related to a lower FFML. CONCLUSION A lower post-surgery FFML was attributable to higher MVPA levels but not protein intake. This may be due to the low total protein intake and the observation that only a minority of patients achieved a protein intake ≥ 60 g/day. Future studies should focus on interventions to increase post-bariatric protein intake and MVPA levels.
Collapse
Affiliation(s)
- Malou A H Nuijten
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. Box 1901, 6500 HB, Nijmegen, The Netherlands
- Nederlandse Obesitas Kliniek, Huis Ter Heide, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. Box 1901, 6500 HB, Nijmegen, The Netherlands
| | - Boy Sanders
- Nederlandse Obesitas Kliniek, Huis Ter Heide, The Netherlands
| | - Laura M Vriese
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. Box 1901, 6500 HB, Nijmegen, The Netherlands
| | | | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | | | - Maria T E Hopman
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. Box 1901, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
10
|
Boniecka I, Czerwonogrodzka-Senczyna A, Jeznach-Steinhagen A, Paśnik K, Szostak-Węgierek D, Zeair S. Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients. Nutrients 2023; 15:nu15112479. [PMID: 37299442 DOI: 10.3390/nu15112479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Iwona Boniecka
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | | | - Anna Jeznach-Steinhagen
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Samir Zeair
- Department of General, Vascular and Transplantation Surgery, Marie Curie Hospital, 71-455 Szczecin, Poland
| |
Collapse
|
11
|
Alvarez TS, Von Atzingen MCBC, Sarni ROS. Sensory analysis of formulations containing whey protein to individuals undergoing bariatric and metabolic surgery. BMC Surg 2023; 23:123. [PMID: 37173643 PMCID: PMC10176954 DOI: 10.1186/s12893-023-02004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Individuals undergoing bariatric surgery often have inadequate protein intake, which can cause loss of lean body mass, low level of physical activity and sarcopenia. The whey protein supplement is the most suitable in this situation, however there is a low adherence to long-term use due to the palatability and monotony of the recipes. The aim this study was to analyze the acceptability of recipes containing whey-based protein supplements in individuals undergoing bariatric and metabolic surgery. METHODS An on-demand sampling was performed, through a prospective, experimental study, with individuals undergoing bariatric surgery, treated by a multidisciplinary team, in a clinic located in São Paulo, Brazil. The study excluded: individuals with possible changes in taste during the sensory testing period. The study was divided into selection of recipes containing whey proteins, recruitment of tasters, sensory and chemical analysis of the recipes. RESULTS The sample consisted of 40 tasters, adults, and elderly, who underwent bariatric and metabolic surgery, with a median of eight years of surgery, who had previously consumed a supplement. These individuals were subjected to sensory analysis of six recipes with fresh and minimally processed foods, plus protein supplement. All recipes had food acceptance above 78% and the chemical analysis of the recipes showed an average of 13 g of protein per serving. CONCLUSION There was favorable acceptance of recipes with whey proteins, which places them as good dietary alternatives for the prevention of sarcopenia and weight relapse in individuals undergoing bariatric and metabolic surgery.
Collapse
Affiliation(s)
- Tatiana Souza Alvarez
- Nutrition Department of the Centro Universitário FMABC, Av. Lauro Gomes, 2000 - Sacadura Cabral, Santo André, São Paulo, CEP 09060-870, Brazil.
| | | | | |
Collapse
|
12
|
de Souza Vilela DL, da Silva A, Pinto SL, Bressan J. Relationship between dietary macronutrient composition with weight loss after bariatric surgery: A systematic review. Obes Rev 2023; 24:e13559. [PMID: 36890787 DOI: 10.1111/obr.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/15/2022] [Accepted: 02/04/2023] [Indexed: 03/10/2023]
Abstract
This systematic review evaluated the relationship between macronutrient intake and weight loss after bariatric surgery (BS). The MEDLINE/Pubmed, EMBASE, COCHRANE/CENTRAL, and SCOPUS databases were accessed in August 2021 to search for eligible articles: original publications with adults undergoing BS and indicating the relationship between macronutrients and weight loss. Titles that did not meet these criteria were excluded. The review was written according to the PRISMA guide, and the risk of bias was according to the Joanna Briggs manual. Data were extracted by one reviewer and checked by another. Eight articles with 2.378 subjects were included. The studies indicated a positive relationship between weight loss and protein intake after BS. Prioritization of protein followed by carbohydrates with a lower percentage of lipids favors weight loss and increases weight stability after BS. Among the results found, a 1% increase in protein intake raises the probability of obesity remission by 6%, and high-protein diet increase 50% weight loss success. Limitations are the methods of included studies and review process. It is concluded that high-protein intake >60 g a 90 g/day may favor weight loss and maintenance after BS, but it is relevant to balance the other macronutrients.
Collapse
Affiliation(s)
- Darlene Larissa de Souza Vilela
- Laboratory of Energy Metabolism and Body Composition (LAMECC). Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Alessandra da Silva
- Laboratory of Energy Metabolism and Body Composition (LAMECC). Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Sônia Lopes Pinto
- Laboratory of Energy Metabolism and Body Composition (LAMECC). Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil.,Nutrition Course, Universidade Federal de Tocantins, Palmas, Tocantins, Brazil
| | - Josefina Bressan
- Laboratory of Energy Metabolism and Body Composition (LAMECC). Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| |
Collapse
|
13
|
Assessment of the Clinical Condition and Way of Patients' Nutrition before and after Laparoscopic Sleeve Gastrectomy. Nutrients 2023; 15:nu15030514. [PMID: 36771221 PMCID: PMC9919987 DOI: 10.3390/nu15030514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
One of the most commonly performed bariatric procedures is the laparoscopic sleeve gastrectomy (LSG). It is highly effective in reducing body weight, but it carries the risk of developing nutritional deficiencies and their consequences. The aim of the study was to determine the clinical condition of obese patients after LSG in terms of nutritional status, metabolic disorders, and way of nutrition. Thirty participants (15 women and 15 men) took part in the study. A statistically significant reduction in the total body fat mass (women by 37.5% p < 0.05, men by 37.06% p < 0.05) and total fat free mass (women by 10% p < 0,05, men by 12.5% p < 0.05) was demonstrated 6 months after LSG. Moreover, insufficient protein intake has been shown in over 73% of women and 40% of men. Before and 6 months after LSG, insufficient intake of calcium, magnesium, potassium, folate, vitamin D, and iron was observed. Six months after the LSG, significant decreases of fasting glucose (p < 0.05), insulin (p < 0.05), TG (p < 0.05), and AST (p < 0.05) concentrations, were observed in both groups. Optimization of nutrition in order to prevent nutritional deficiencies and their complications is a key element of the therapy of obese patients treated surgically.
Collapse
|
14
|
Associations of age, sex, and socioeconomic status with adherence to guideline recommendations on protein intake and micronutrient supplementation in patients with sleeve gastrectomy or Roux-en-Y gastric bypass. PLoS One 2023; 18:e0282683. [PMID: 36867644 PMCID: PMC9983924 DOI: 10.1371/journal.pone.0282683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Patients with bariatric surgery often show poor long-term compliance to recommendations for prevention of nutrient deficiency but it is unclear which factors contribute. We investigated the associations of age, sex, and socioeconomic status (SES) with adherence to guideline recommendations on protein intake and micronutrient supplementation. METHODS In a monocentric cross-sectional study we prospectively recruited patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) and a minimum postoperative period of 6 months. Clinical and demographic data were obtained from the patients' medical files and by questionnaire. Patients reported on supplement usage, recorded their dietary intake for seven days and underwent physical examinations including blood testing. RESULTS We included 35 patients (SG: n = 25, RYGB: n = 10) with a mean (+SD) postoperative period of 20.2 (±10.4) months. Distributions of age, sex and SES were comparable between the SG and RYGB groups. Non-adherence to recommended protein intake was associated with age ≥ 50 years (p = 0.041) but not sex or SES. Protein intake inversely correlated with markers of obesity. There were no significant associations of age or sex with micronutrient supplementation. Only for vitamins A (p = 0.049) and B1 (p = 0.047) higher SES was associated with greater compliance. The only manifest deficiency associated with non-adherence to micronutrient supplementation was that for folic acid (p = 0.044). CONCLUSION In patients after bariatric surgery, those of older age and of lower SES might have a greater risk of unfavorable outcome and may require greater attention to micronutrient and protein supplementation.
Collapse
|
15
|
Alshamari S, Aly Elsherif M, Hanna F, El Akhal L, Abid H, Elhag W. The effect of protein supplements on weight loss, body composition, protein status, and micronutrients post laparoscopic sleeve gastrectomy (LSG): A Randomised Controlled Trial (RCT). Ann Med Surg (Lond) 2022; 74:103220. [PMID: 35070287 PMCID: PMC8762356 DOI: 10.1016/j.amsu.2021.103220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Low protein intake post-bariatric surgery can result in protein malnutrition, and muscle mass loss. Authors aim to assess the effect of protein supplements on weight loss, body composition, and micronutrient status following LSG. Methods This is a double-blinded RCT conducted between February/2017 to January/2018. Eligible post LSG patients were randomized into the intervention group who received daily protein supplements containing 20 g of protein and placebo group received zero protein supplements. Both groups received a standardized diet. Weight loss, body composition, and micronutrient status were analyzed at 1, 3, and 6 months. Results 48 participants were included in the final analysis (intervention: 21 and placebo:27). Excess weight loss percentage (EWL%) at 6 months was comparable between both groups (69.44 ± 21.99% and 71.40 ± 19.27% respectively). No significant difference observed in the anthropometric parameters. There was an increase in muscle mass and a decrease in muscle mass loss in the intervention group throughout the study period. However, these changes were not statistically significant. There was a significant increase in total protein (P=0.027) and magnesium (P=0.008) in the intervention group at 3 months. Albumin and iron levels were significantly higher at 6 months in the intervention group (P=0.036 & P=0.028 respectively). Other micronutrients did not differ at any time point between both groups. Conclusion Protein supplements resulted in significant improvement in total protein, albumin, magnesium, and iron levels post LSG. Although not significant, protein supplements helped in maintaining the muscle mass and preventing muscle mass loss. Original article This RCT is an original article and provides a level 2 evidence. Low protein intake post-bariatric surgery results in protein malnutrition & muscle mass loss. Protein supplements may be of benefit. Eligible post LSG patients were randomized into the intervention group who received daily 20 g protein supplements & placebo group. No significant difference in weight, BMI, BMI change, EWL%, TWL%, and absolute weight loss. No statistically significant changes in the muscle mass. Percentage of muscle mass loss was noticeably higher in the control group over the 3 timelines. Fat percentages were less in the intervention group. Total protein and Albumin showed a significant increase in the intervention group.
Collapse
|
16
|
Hanna DJ, Jamieson ST, Lee CS, Pluskota CA, Bressler NJ, Benotti PN, Khurana S, Rolston DDK, Still CD. "Bioelectrical impedance analysis in managing sarcopenic obesity in NAFLD". Obes Sci Pract 2021; 7:629-645. [PMID: 34631140 PMCID: PMC8488453 DOI: 10.1002/osp4.509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Sarcopenic obesity and its association with nonalcoholic fatty liver disease (NAFLD) is under-recognized by many healthcare providers in Western medicine due to the lack of awareness and diagnostic guidelines. The result is delayed recognition and treatment, which leads to further health deterioration and increased healthcare costs. Sarcopenic obesity is characterized by the presence of increased fat mass in combination with muscle catabolism related to chronic inflammation and/or inactivity. Previous research has recommended evaluating body composition and physical function performance to adequately diagnose sarcopenic obesity. Body composition analysis can be performed by imaging applications through magnetic resonance imaging, computed tomography, and dual-energy x-ray absorptiometry. Due to the cost of each device and radiation exposure for patients as evidenced in all three modalities, bioelectrical impedance analysis offers a noninvasive approach capable of providing quick and reliable estimates of lean body and fat mass. METHODS AND RESULTS This review analyzes the current evidence-based literature, indicating a lower skeletal muscle mass and increased visceral adipose tissue correlation to the advancement of fibrosis in fatty liver disease. CONCLUSION Given the substantial promising research conducted in predominantly Asian populations regarding body tissue distribution and NAFLD, additional prospective research is needed to extend these findings in Western populations.
Collapse
Affiliation(s)
- David J. Hanna
- Obesity InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Department of Gastroenterology and HepatologyGeisinger Health SystemDanvillePennsylvaniaUSA
| | | | | | | | | | | | - Sandeep Khurana
- Department of Gastroenterology and HepatologyGeisinger Health SystemDanvillePennsylvaniaUSA
| | - David D. K. Rolston
- Obesity InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Department of Internal MedicineGeisinger Health SystemDanvillePennsylvaniaUSA
| | | |
Collapse
|
17
|
Hansen D, Decroix L, Devos Y, Nocca D, Cornelissen V, Dillemans B, Lannoo M. Towards Optimized Care After Bariatric Surgery by Physical Activity and Exercise Intervention: a Review. Obes Surg 2021; 30:1118-1125. [PMID: 31912467 DOI: 10.1007/s11695-020-04390-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
Collapse
Affiliation(s)
- Dominique Hansen
- Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan, Building A, Diepenbeek, 3590, Hasselt, Belgium. .,Hasselt University, BIOMED, Hasselt, Belgium. .,Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.
| | - Lieselot Decroix
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Devos
- Fitness als Medicijn®-Medisch Fitness Centrum, Ternat, Belgium
| | - David Nocca
- Department of Surgery, Université de Montpellier, Montpellier, France
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
| | | |
Collapse
|
18
|
Romeijn MM, Holthuijsen DDB, Kolen AM, Janssen L, Schep G, van Dielen FMH, Leclercq WKG. The effect of additional protein on lean body mass preservation in post-bariatric surgery patients: a systematic review. Nutr J 2021; 20:27. [PMID: 33715633 PMCID: PMC7958440 DOI: 10.1186/s12937-021-00688-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As result of bariatric surgery, patients are susceptible to protein deficiency which can result in undesirable lean body mass (LBM) loss. Consumption of high-protein diets or supplements could counteract this, but evidence about the effect is scarce. This paper systematically reviewed the literature to determine the effect of additional protein intake (≥60 g/day) on LBM preservation in post-bariatric patients. METHODS An electronic search of PubMed, EMBASE and the Cochrane Library was conducted. Studies were included if patients received a high-protein diet or protein supplements for at least one month, and LBM was assessed. The primary outcome was difference in mean LBM loss between the experimental (protein) and control group. Secondary outcomes were differences in body fat mass, total body water, body mass index and resting metabolic rate. RESULTS Two of the five included studies (n = 223) showed that consumption of proteins resulted in significant LBM preservation. Only one study reported a significant difference in the reduction of body fat mass and resting metabolic rate in favour of a high-protein diet, but none of the studies showed a significant difference in total body water loss or body mass index change between the two groups. CONCLUSIONS This paper showed inconclusive evidence for LBM preservation due to protein supplementation or a high-protein diet in post-bariatric patients. This outcome might be subjected to certain limitations, including a lack of blinding and a low compliance rate reported in the included studies. More specific and personalized recommendations regarding protein intake may need to be established by high quality research. Studies investigating the quantity (g/day) and quality (whey, casein or soy) of proteins are also needed.
Collapse
Affiliation(s)
- Marleen M Romeijn
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands. .,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Daniëlle D B Holthuijsen
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands.,Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Aniek M Kolen
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands.,Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Goof Schep
- Department of Sport Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - François M H van Dielen
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Wouter K G Leclercq
- Department of Surgery, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| |
Collapse
|
19
|
Bertoni L, Valentini R, Zattarin A, Belligoli A, Bettini S, Vettor R, Foletto M, Spinella P, Busetto L. Assessment of Protein Intake in the First Three Months after Sleeve Gastrectomy in Patients with Severe Obesity. Nutrients 2021; 13:nu13030771. [PMID: 33673465 PMCID: PMC7997257 DOI: 10.3390/nu13030771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
An adequate protein intake prevents the loss of fat-free mass during weight loss. Laparoscopic sleeve gastrectomy (SG) jeopardizes protein intake due to post-operative dietary restriction and intolerance to protein-rich foods. The purpose of this study is to evaluate protein intake in the first three months after SG. We evaluated, 1 month and 3 months after surgery, 47 consecutive patients treated with SG. Protein intake, both from foods and from protein supplementation, was assessed through a weekly dietary record. Patients consumed 30.0 ± 10.2 g of protein/day on average from foods in the first month, with a significant increase to 34.9 ± 4.8 g of protein/day in the third month (p = 0.003). The use of protein supplementation significantly increased total protein intake to 42.3 ± 15.9 g protein/day (p < 0.001) in the first month and to 39.6 ± 14.2 g of protein/day (p = 0.002) in the third one. Compliance with supplement consumption was 63.8% in the first month and only 21.3% in the third month. In conclusion, both one and three months after SG, protein intake from foods was not sufficient. The use of modular supplements seems to have a significant impact on protein intake, but nevertheless it remains lower than recommended.
Collapse
Affiliation(s)
- Lucrezia Bertoni
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Romina Valentini
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
| | - Alessandra Zattarin
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Anna Belligoli
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Silvia Bettini
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Mirto Foletto
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Paolo Spinella
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
| | - Luca Busetto
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-8250
| |
Collapse
|
20
|
Englert I, Bosy-Westphal A, Bischoff SC, Kohlenberg-Müller K. Impact of Protein Intake during Weight Loss on Preservation of Fat-Free Mass, Resting Energy Expenditure, and Physical Function in Overweight Postmenopausal Women: A Randomized Controlled Trial. Obes Facts 2021; 14:259-270. [PMID: 33975325 PMCID: PMC8255642 DOI: 10.1159/000514427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/31/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Weight loss in old age increases the risk of sarcopenia caused by the age-related reduction of fat-free mass (FFM). Due to the strong correlation between FFM and resting energy expenditure (REE), the maintenance of this must also be considered. Besides, the physical function (PF) must be maintained. OBJECTIVE The impact of protein intake on changes in FFM, REE, and PF during weight loss in overweight postmenopausal women was investigated. METHODS Fifty-four postmenopausal women (BMI 30.9 ± 3.4; age 59 ± 7 years) were randomized into 2 groups receiving energy-restricted diets with either 0.8 g (normal protein; NP) or 1.5 g protein/kg body weight (high protein; HP) for 12 weeks, followed by a 6-month follow-up phase with an ad libitum food intake. FFM, REE, and PF (strength, endurance, and balance) were measured at baseline, after weight loss, and after follow-up. RESULTS Forty-six women completed the weight loss intervention and 29 were followed up. The weight loss was -4.6 ± 3.6 kg (HP) and -5.2 ± 3.4 kg (NP; both p < 0.001) and the weight regain during follow-up was 1.3 ± 2.8 kg (HP; p = 0.03) and 0.4 ± 2.5 kg (NP; p = 0.39), with no differences between groups. Similar decreases in FFM (-0.9 ± 1.1 [HP] vs. -1.0 ± 1.3 kg [NP]) and REE (-862 ± 569 [HP] vs. -1,000 ± 561 kJ [NP]; both p < 0.001) were observed in both groups. During follow-up, no changes in FFM were detected in either group, whereas in the NP group the REE increased again (+138 ± 296; p = 0.02). The main determinants of FFM loss were the energy deficit and the speed of weight loss. In the NP group, the Short Physical Performance Battery score improved with weight loss (+0.6 ± 0.8; p < 0.001) and handgrip strength decreased (-1.7 ± 3.4 kg; p < 0.001), whereas no changes were observed in the HP group. CONCLUSIONS An HP weight-loss diet without exercise had no impact on preservation of FFM and REE but may help to maintain muscle strength in postmenopausal women.
Collapse
Affiliation(s)
- Isabell Englert
- Fulda University of Applied Sciences, Fulda, Germany
- *Isabell Englert,
| | | | | | | |
Collapse
|
21
|
Complications nutritionnelles de la chirurgie de l’obésité : prévalence, prévention, traitement. Revue systématique de littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
22
|
Hirsch KR, Blue MNM, Trexler ET, Ahuja S, Smith-Ryan AE. Provision of ready-to-drink protein following bariatric surgery: An evaluation of tolerability, body composition, and metabolic rate. Clin Nutr 2020; 40:2319-2327. [PMID: 33158590 DOI: 10.1016/j.clnu.2020.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 08/09/2020] [Accepted: 10/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS It is recommended that patients consume at least 60 g of dietary protein per day to attenuate loss of fat-free mass (FFM) following bariatric surgery. To date, research on the effectiveness and tolerability of protein supplementation in bariatric patients is limited. The purpose of the current study was to determine if provision of 12-weeks of daily protein supplementation was an effective and tolerable method of facilitating higher protein intakes in bariatric surgery patients. A secondary aim was to evaluate the effects of protein supplementation on body composition, metabolic rate, and functional outcomes. An exploratory aim was to compare body composition estimates from bioelectrical impedance spectroscopy and dual-energy x-ray absorptiometry. METHODS Bariatric surgery patients (n = 49; 88% female) (mean ± standard deviation; Age: 43.7 ± 10.7 yrs; BMI: 51.2 ± 13.7 kg m-2) were provided with either a 12-week supply of ready-to-drink protein shakes (PRO; n = 25) or instructed to follow standard-of-care recommendations (SOC; n = 24) following surgery. Patients completed measures of body composition (fat mass [FM], percent body fat [%BF], FFM; bioelectrical impedance [BIS] and/or dual-energy x-ray absorptiometry [DXA]), resting metabolic rate (RMR; indirect calorimetry), a 30-s chair stand, and 3-day food logs prior to surgery (base), 3-weeks, 12-weeks, and 24-weeks post-surgery. RESULTS About 80% of all patients achieved the recommended intake of 60 g per day, with no significant differences in protein intake between groups (p < 0.05). Patients in PRO were more likely to increase protein consumption over the course of the entire intervention compared to SOC. Both groups experienced significant decreases in weight, BMI, %BF, FM, FFM, and total body water (TBW) (p < 0.05). The percentage of weight lost as FFM was significantly greater when measured by BIS (39.1%) compared to when measured by DXA (17.8%) (p < 0.05). There was a significant decrease in RMR from base-3 weeks for both groups (p = 0.002; 95% confidence interval [-370.6, -90.7]); there were no significant changes after 3 weeks (p > 0.05). The number of sit-to-stand trials increased at each testing session after the first 3 weeks (p < 0.05). CONCLUSIONS Patients were able to achieve the recommended 60 g of protein per day post-surgery, but the provision of ready-to-drink protein shakes may help bariatric patients achieve higher post-surgery protein intakes. Both groups experienced significant decreases in weight, BMI, and body composition; results varied depending on the method of body composition used. Changes in FFM measured by BIS may reflect greater changes in TBW as opposed to actual muscle mass. Registered at ClinicalTrials.gov, ID#NCT02951663.
Collapse
Affiliation(s)
- Katie R Hirsch
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
| | - Malia N M Blue
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
| | - Eric T Trexler
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
| | - Shawn Ahuja
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abbie E Smith-Ryan
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA.
| |
Collapse
|
23
|
Beavers KM, Greene KA, Yu EW. MANAGEMENT OF ENDOCRINE DISEASE: Bone complications of bariatric surgery: updates on sleeve gastrectomy, fractures, and interventions. Eur J Endocrinol 2020; 183:R119-R132. [PMID: 32869608 PMCID: PMC8254876 DOI: 10.1530/eje-20-0548] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.
Collapse
Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
24
|
Ziadlou M, Hosseini-Esfahani F, Mozaffari Khosravi H, Hosseinpanah F, Barzin M, Khalaj A, Valizadeh M. Dietary macro- and micro-nutrients intake adequacy at 6th and 12th month post-bariatric surgery. BMC Surg 2020; 20:232. [PMID: 33046020 PMCID: PMC7549200 DOI: 10.1186/s12893-020-00880-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bariatric surgery (BS) is considered as an effective solution to control morbid obesity. Food restrictions resulting from the operation may decrease dietary nutrient intakes, particularly during the first year after BS. This study mainly aimed to assess the adequacy of dietary nutrient intakes at 6th and 12th month after BS. METHOD Of the severely obese participants in the Tehran obesity treatment study in 2015-2016, 58 patients undergoing Roux-En-Y gastric bypass (N = 16) or sleeve gastrectomy (N = 42) were selected from Tehran Obesity Treatment Center. To assess the patients' dietary intake, a three-day, 24-h dietary recall was obtained on three unscheduled days (two non-consecutive weekdays and one weekend day) at 6th and 12th month after BS. To evaluate the adequacy of nutrient intake, the patients' intakes were compared to the current dietary reference intakes (DRIs), including estimated average requirements (EAR) or Adequate Intakes (AI). RESULTS The mean age of the participants (71% women) undergoing BS was 37 ± 8 years. Anthropometric parameters significantly decreased at the 12th month after BS. The percentage of energy from carbohydrate intake increased significantly between the 6th and 12th month after BS (P = 0.04). The mean ± SD of protein intake was lower than the recommended dosage with a dramatic decrease from 45 ± 30 to 31 ± 15 (g/day) between the two intervals (P = 0.001). The mean intake of saturated fatty acid (SFA) decreased dramatically (P < 0.001) from 6 to 12 month; however, the median intake of n3-polyunsaturated fatty acid (n3-PUFA) intake increased (P = 0.02). None of the participants showed nutrient intake adequacy in terms of biotin, fat soluble vitamins, pantothenic acid, potassium, and zinc. Moreover, less than 10% of the participants showed nutrient intake adequacy in terms of folate, magnesium, manganese, and calcium according to DRIs during the both intervals after BS. CONCLUSION Bariatric surgery can reduce dietary intakes, which is more obvious 12 months after the surgery. Out of 21 micronutrients, nearly all could not met the EAR and were received < 50%, also had significant reduction from the 6th to12th month after surgery.
Collapse
Affiliation(s)
- Maryam Ziadlou
- International Campus of Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Firoozeh Hosseini-Esfahani
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hassan Mozaffari Khosravi
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Alireza Khalaj
- Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran.
| |
Collapse
|
25
|
Swierz MJ, Storman D, Jasinska KW, Storman M, Staskiewicz W, Gorecka M, Skuza A, Tobola P, Bala MM. Systematic review and meta-analysis of perioperative behavioral lifestyle and nutritional interventions in bariatric surgery: a call for better research and reporting. Surg Obes Relat Dis 2020; 16:2088-2104. [PMID: 33036943 DOI: 10.1016/j.soard.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
Bariatric surgery is considered the most effective treatment for people with morbid obesity, and certain interventions could enhance its long-term results. We searched MEDLINE, Embase, Web of Science, CENTRAL, and trial registers up to January 1, 2020. Randomized controlled trials, where behavioral lifestyle or nutritional interventions were provided perioperatively were included. Primary outcome was weight change. Two reviewers independently performed each stage of the review. Altogether 6652 references were screened. 31 studies were included for qualitative synthesis and 22 studies for quantitative synthesis. Interventions varied greatly, thus limiting possibility of synthesizing all results. Six groups of interventions were discerned, and we used standardized mean differences for synthesis. Low to very-low certainty evidence suggests that physical activity, nonvitamin nutritional interventions, vitamins, psychotherapy, and counseling but not combined interventions might bring some benefit regarding short-term postsurgery follow-ups (up to 12 mo), but the estimates varied and results were not statistically significant, except for 12 months follow-ups regarding counseling. Psychotherapy and counseling, but not vitamins and combined interventions, may provide some benefit at longer follow-ups (over 12 mo), but the certainty of evidence was low to very-low and statistically significant results were observed in comparisons including data from single studies with small sample sizes only. Included studies expressed an outcome "weight change" using 20 different measures. Misreporting of data and huge variety of outcomes do not benefit systematic analyses and may possibly lead to confusion of both researchers and readers. We suggest that authors follow a predefined set of outcomes when reporting the results of their studies. The initiative to produce "core outcome set" for clinical trials in bariatric surgery trials is currently underway.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Tobola
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.
| |
Collapse
|
26
|
Bariatric surgery affects obesity-related protein requirements. Clin Nutr ESPEN 2020; 40:392-400. [PMID: 33183568 DOI: 10.1016/j.clnesp.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT Following bariatric surgery, protein deficiency intakes are reported in morbidly obese patients, whereas post-bariatric protein requirements are not specifically defined with validated method in this population. OBJECTIVE To assess average protein requirement (APR) in obese subjects, before, 3 months and 12 months after bariatric surgery using the validated method of nitrogen balance. DESIGN AND SETTING Prospective longitudinal study conducted in 21 morbidly obese patients (BMI 43.9 ± 1.4 kg/m2) before (M0), 3 months (M3) and 12 months (M12) after sleeve gastrectomy or Roux-en-Y gastric by-pass. An additional larger cross-sectional study was performed to validate APR before surgery in non-operated matched obese patients (n = 106). APR was evaluated at M0, M3, M12 by measuring 3 days dietary intakes together with losses of nitrogen in urine and stools. MAIN OUTCOME MEASURE APR was defined as the mean value of protein intake required to achieve balance nitrogen equilibrium. RESULTS Before surgery, APR in morbidly obese patients was 0.76 [95%CI, 0.66-0.92] g/kg Body Weight (BW)/d in the experimental group, and 0.74 [0.70-0.80] g/kg BW/d in the validation group. APR was 0.62 [0.51-0.75] g/kg/d at M3 and 0.87 [0.75-0.98] g/kg/d at M12, with no difference between surgical procedures. Spontaneous protein intakes were respectively 0.80 ± 0.05, 0.43 ± 0.03 and 0.71 ± 0.04 g/kg BW/d respectively at M0, M3 and M12. CONCLUSION This study demonstrates a temporal change in protein requirement after bariatric surgery whatever the type of surgery. Spontaneous protein intakes following bariatric surgery does not cover protein requirements for most patients, suggesting that specific dietary protein recommandations have to be adapted in obese patients with bariatric surgery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01249326.
Collapse
|
27
|
Martínez-Ortega AJ, Olveira G, Pereira-Cunill JL, Arraiza-Irigoyen C, García-Almeida JM, Irles Rocamora JA, Molina-Puerta MJ, Molina Soria JB, Rabat-Restrepo JM, Rebollo-Pérez MI, Serrano-Aguayo MP, Tenorio-Jiménez C, Vílches-López FJ, García-Luna PP. Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery. Nutrients 2020; 12:E2002. [PMID: 32640531 PMCID: PMC7400832 DOI: 10.3390/nu12072002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
Abstract
In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4-8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1-1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.
Collapse
Affiliation(s)
- Antonio J. Martínez-Ortega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- CIBERDEM (CB07/08/0019), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José L. Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | | | - José M. García-Almeida
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Unidad de gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | | | - María I. Rebollo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - María P. Serrano-Aguayo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Carmen Tenorio-Jiménez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | | | - Pedro P. García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
- GARIN Group Coordinator, 41007 Seville, Spain
| |
Collapse
|
28
|
Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg 2020; 29:3385-3400. [PMID: 31367987 DOI: 10.1007/s11695-019-04112-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
Collapse
Affiliation(s)
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Opposite of the Shariati Hospital, Tehran, 14395-578, Iran.
| |
Collapse
|
29
|
Vilallonga R, Pereira-Cunill JL, Morales-Conde S, Alarcón I, Breton I, Domínguez-Adame E, Ferrer JV, Ruiz-de-Gordejuela AG, Goday A, Lecube A, García-Almenta EM, Rubio MÁ, Tinahones FJ, García-Luna PP. A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity. Obes Surg 2020; 29:3842-3853. [PMID: 31342249 DOI: 10.1007/s11695-019-04043-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). METHOD The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. RESULTS Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). CONCLUSION In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.
Collapse
Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J L Pereira-Cunill
- Clinical Nutritión Unit, Endocrinology and Nutrition Service, University Hospital "Virgen del Rocío", Seville, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Breton
- Unidad de Nutrición Clínica y Dietética del Servicio de Endocrinología y Nutrición del Hospital Gregorio Marañón, Madrid, Spain
| | - E Domínguez-Adame
- UGC Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - A Garcia Ruiz-de-Gordejuela
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Goday
- Servicio de Endocrinología, Hospital del Mar de Barcelona, Departament de Medicina, CIBERobn, ISCIII, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Lecube
- Servicio deEndocrinología y Nutrición, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Avda. Rovira Roure, 80 25198, Lleida, Spain
| | - E Martín García-Almenta
- Unidad Cirugía Esófago-Gástrica, Metabólica y Bariátrica, Hospital Clínico San Carlos, Madrid, Spain
| | - M Á Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Idissc, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - F J Tinahones
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Málaga, Spain
| | - P P García-Luna
- Unidad de Nutrición Clínica y de la Unidad de Obesidad Mórbida (Unidad de Gestión de Endocrinología y Nutrición, UGEN), Hospital Universitario Virgen del Rocío, Seville, Spain
| |
Collapse
|
30
|
Osland E, Powlesland H, Guthrie T, Lewis CA, Memon MA. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S9. [PMID: 32309413 PMCID: PMC7154332 DOI: 10.21037/atm.2019.06.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Bariatric surgery is increasingly being utilized to manage obesity and obesity related comorbidities, but may lead to the development of micronutrient deficiencies postoperatively. The anatomical, physiological, nutritional and behavioral reasons for micronutrient vulnerabilities are reviewed, along with recommendations for routine monitoring and replacement following surgery. The role the dietitian and their contribution in the postoperative identification, prevention and management of micronutrient vulnerabilities in bariatric patients is described. Specific considerations such as the nutritional and dietetic management of pregnant and lactating women post-bariatric surgery is also discussed.
Collapse
Affiliation(s)
- Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Carrie-Anne Lewis
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Mayne Medical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Muhammed Ashraf Memon
- Sunnybank Obesity Centre, McCullough Centre, Sunnybank, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, Queensland, Australia.,Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
| |
Collapse
|
31
|
Moore JM, Haemer MA, Fox CK. Lifestyle and pharmacologic management before and after bariatric surgery. Semin Pediatr Surg 2020; 29:150889. [PMID: 32238284 PMCID: PMC8456424 DOI: 10.1016/j.sempedsurg.2020.150889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
Collapse
Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| |
Collapse
|
32
|
Bhatia IN, Nasta AM, Goel MR, Goel RG. Prevalent bariatric dietary practices: Is India on the same page? J Minim Access Surg 2020; 16:381-385. [PMID: 31997784 PMCID: PMC7597891 DOI: 10.4103/jmas.jmas_205_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: In the past decade, there has been an increase in the number and types of bariatric procedures in India. It is, thus, important to monitor prevalent bariatric practices. Aim: To identify prevalent pre- and post-operative dietary practices by bariatric professionals across India. Materials and Methods: Data regarding various pre- and post-surgery dietary practices were collected using an Internet-based survey. Thirty-three bariatric professionals including dietitians (n = 25) and surgeons (n = 8) across the country participated in the survey. The data were analysed, and prevalent dietary practices were identified. Results: Five (20%) dietitians were not involved in the pre-surgery consultation. Nineteen (70%) professionals put all patients on a low-calorie pre-surgery diet regardless of their body mass index, with a preference (n = 21; 77.7%) for liquid diet. Twenty-three (70%) professionals put patients on post-surgery liquid diet for 1–2 weeks. Thereafter, 28 (84.8%) professionals recommended soft diet for 2–4 weeks. Twenty-seven (81%) professionals used protein shakes (as opposed to dietary sources) as their primary source of protein for the first 3 months post-surgery. Fourteen (36%) professionals stopped protein shake supplements within 6 months post-surgery. Ten (30%) professionals reported whey protein aversions in >25% of the patients. Twenty-three (71%) professionals advocated a meal with <30% of carbohydrates for up to 1 year. Twenty-eight (84%) professionals used portion control method for meals. Conclusion: Our study reflects that prevalent dietary practices among Indian bariatricians are in line with national and international guidelines.
Collapse
Affiliation(s)
- Ishitaa N Bhatia
- Department of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Amrit M Nasta
- Department of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Madhu R Goel
- Department of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Ramen G Goel
- Department of Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
33
|
Voils CI, Adler R, Strawbridge E, Grubber J, Allen KD, Olsen MK, McVay MA, Raghavan S, Raffa SD, Funk LM. Early-phase study of a telephone-based intervention to reduce weight regain among bariatric surgery patients. Health Psychol 2020; 39:391-402. [PMID: 31999175 DOI: 10.1037/hea0000835] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study describes early-phase development of a behavioral intervention to reduce weight regain following bariatric surgery. We utilized the Obesity-Related Behavioral Intervention Trials model to guide intervention development and evaluation. We sought to establish recruitment, retention, and fidelity monitoring procedures; evaluate feasibility of utilizing weight from the electronic medical record (EMR) as an outcome; observe improvement in behavioral risk factors; and evaluate treatment acceptability. METHOD The intervention comprised 4 weekly telephone calls addressing behavior change strategies for diet, physical activity, and nutrition supplement adherence and 5 biweekly calls addressing weight loss maintenance constructs. Veterans (N = 33) who received bariatric surgery 9-15 months prior consented to a 16-week, pre-post study. Self-reported outcomes were obtained by telephone at baseline and 16 weeks. Clinic weights were obtained from the EMR 6 months pre- and postconsent. Qualitative interviews were conducted at 16 weeks to evaluate treatment acceptability. We aimed to achieve a recruitment rate of ≥ 25% and retention rate of ≥ 80%, and have ≥ 50% of participants regain < 3% of their baseline weight. RESULTS Results supported the feasibility of recruiting (48%) and retaining participants (93% provided survey data; 100% had EMR weight). Pre-post changes in weight (73% with < 3% weight regain) and physical activity (Cohen's ds 0.38 to 0.52) supported the potential for the intervention to yield clinically significant results. Intervention adherence (mean 7.8 calls of 9 received) and positive feedback from interviews supported treatment acceptability. CONCLUSIONS The intervention should be evaluated in an adequately powered randomized controlled trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luke M Funk
- William S. Middleton Memorial Veterans Hospital
| |
Collapse
|
34
|
Abstract
Dietary protein is crucial for human health because it provides essential amino acids for protein synthesis. In addition, dietary protein is more satiating than carbohydrate and fat. Accordingly, many people consider the protein content when purchasing food and beverages and report 'trying to eat more protein'. The global market for protein ingredients is projected to reach approximately US$90 billion by 2021, largely driven by the growing demand for protein-fortified food products. This Perspective serves as a caution against the trend of protein-enriched diets and provides an evidence-based counterpoint that underscores the potential adverse public health consequences of high protein intake.
Collapse
Affiliation(s)
- Bettina Mittendorfer
- Center for Human Nutrition, Washington University School of Medicine, St Louis, MO, USA.
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St Louis, MO, USA
| | - Luigi Fontana
- Center for Human Nutrition, Washington University School of Medicine, St Louis, MO, USA
- Charles Perkins Center, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
35
|
Jain AK, le Roux CW, Puri P, Tavakkoli A, Gletsu-Miller N, Laferrère B, Kellermayer R, DiBaise JK, Martindale RG, Wolfe BM. Proceedings of the 2017 ASPEN Research Workshop-Gastric Bypass: Role of the Gut. JPEN J Parenter Enteral Nutr 2019; 42:279-295. [PMID: 29443403 DOI: 10.1002/jpen.1121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
Abstract
The goal of the National Institutes of Health-funded American Society for Parenteral and Enteral Nutrition 2017 research workshop (RW) "Gastric Bypass: Role of the Gut" was to focus on the exciting research evaluating gut-derived signals in modulating outcomes after bariatric surgery. Although gastric bypass surgery has undoubted positive effects, the mechanistic basis of improved outcomes cannot be solely explained by caloric restriction. Emerging data suggest that bile acid metabolic pathways, luminal contents, energy balance, gut mucosal integrity, as well as the gut microbiota are significantly modulated after bariatric surgery and may be responsible for the variable outcomes, each of which was rigorously evaluated. The RW served as a timely and novel academic meeting that brought together clinicians and researchers across the scientific spectrum, fostering a unique venue for interdisciplinary collaboration among investigators. It promoted engaging discussion and evolution of new research hypotheses and ideas, driving the development of novel ameliorative, therapeutic, and nonsurgical interventions targeting obesity and its comorbidities. Importantly, a critical evaluation of the current knowledge regarding gut-modulated signaling after bariatric surgery, potential pitfalls, and lacunae were thoroughly addressed.
Collapse
Affiliation(s)
- Ajay Kumar Jain
- Department of Pediatrics, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Carel W le Roux
- Diabetes Complications Research Center, University College Dublin, School of Medicine, Dublin, Ireland
| | - Puneet Puri
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Vieginia, USA
| | - Ali Tavakkoli
- Brigham and Women's Hospital, Center for Weight Management and Metabolic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Blandine Laferrère
- Department of Medicine, Division of Endocrinology, Columbia University, New York, New York, USA
| | | | - John K DiBaise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
36
|
Anker MS, Anker SD, Coats AJ, von Haehling S. The Journal of Cachexia, Sarcopenia and Muscle stays the front-runner in geriatrics and gerontology. J Cachexia Sarcopenia Muscle 2019; 10:1151-1164. [PMID: 31821753 PMCID: PMC6903443 DOI: 10.1002/jcsm.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of CardiologyCharité Campus Benjamin FranklinBerlinGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center GöttingenUniversity of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
- German Center for Cardiovascular Medicine (DZHK), partner site GöttingenGöttingenGermany
| |
Collapse
|
37
|
Güneş Y, Karip B, Ergin A, Esen Bulut N, Fersahoğlu MM, Memişoğlu K. The Impact of Protein Support on Weight Loss, Sarcopenia, and Quality of Life After Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Patnos State Hospital, Ağrı, Turkey
| | - Bora Karip
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Anıl Ergin
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mahir Fersahoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kemal Memişoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
38
|
Gletsu-Miller N. A successful nutritional therapy for postprandial hypoglycemia after bariatric surgery. Am J Clin Nutr 2019; 110:267-268. [PMID: 31075792 DOI: 10.1093/ajcn/nqz059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nana Gletsu-Miller
- Department of Nutrition Science/College of Health and Human Sciences, Purdue University, West Lafayette, IN
| |
Collapse
|
39
|
Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial. Obes Surg 2019; 29:2503-2510. [PMID: 30997619 DOI: 10.1007/s11695-019-03879-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. METHODS In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30-39.9 kg/m2, we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. RESULTS Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL - 5.2%, AGB - 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB - 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB - 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB - 12.38%, RYGB - 7.29%, p = 0.15). CONCLUSIONS At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. CLINICAL TRIAL REGISTRATION NCTDK089557 - ClinicalTrials.gov.
Collapse
|
40
|
Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
Collapse
Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
41
|
Becroft L, Ooi G, Forsyth A, King S, Tierney A. Validity of multi-frequency bioelectric impedance methods to measure body composition in obese patients: a systematic review. Int J Obes (Lond) 2018; 43:1497-1507. [PMID: 30568268 DOI: 10.1038/s41366-018-0285-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/15/2018] [Accepted: 11/28/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Excessive lean tissue loss following bariatric surgery may pose serious metabolic consequences. Accurate methods to assess body composition following bariatric surgery are required. This review aimed to investigate if multi-frequency bioelectric impedance (MF-BI) is a valid tool to determine body composition in obese patients. METHODS MEDLINE, EMBASE, CINAHL and CENTRAL databases were searched until March 2017. Included studies were published in English with obese (body mass index (BMI) ≥ 30 kg/m2) adults measuring body composition with MF-BI methods in comparison with reference methods. Exclusions were pregnancy, animal studies, non-English language studies, single frequency BI. A total of 6395 studies were retrieved. RESULTS Sixteen studies were eligible for inclusion. Sample sizes ranged from 15 to 157, with BMI 26-48 kg/m2. MF-BI underestimated fat mass (FM) in 11 studies and overestimated fat-free mass (FFM) in nine studies in comparison with reference methods. Correlations of absolute values from MF-BI and reference methods for FM and FFM were high, however, agreement was lower at an individual level. When adjustments for BMI were made to machine algorithms, measurement accuracy improved. Significant heterogeneity was evident among included studies. CONCLUSIONS This review found that MF-BI is reliable for use at a group level. Obese-specific adjustment of algorithms for MF-BI machines increases the accuracy of absolute measures of body composition in obese individuals, improving their utility in the clinical setting. Multiple variables contributed a lack of consistency among studies included, highlighting the need for more robust studies that control confounding variables to establish clear validity assessment.
Collapse
Affiliation(s)
- Louise Becroft
- Nutrition Department, The Alfred, Melbourne, Victoria, Australia. .,Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Victoria, Australia.
| | - Geraldine Ooi
- Monash University Department of Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Adrienne Forsyth
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Victoria, Australia
| | - Susannah King
- Nutrition Department, The Alfred, Melbourne, Victoria, Australia.,Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Victoria, Australia
| | - Audrey Tierney
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Victoria, Australia.,School of Allied Health, University of Limerick, Limerick, Ireland
| |
Collapse
|
42
|
Kheniser KG, Polanco Santos CM, Kashyap SR. The effects of diabetes therapy on bone: A clinical perspective. J Diabetes Complications 2018; 32:713-719. [PMID: 29747995 DOI: 10.1016/j.jdiacomp.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/21/2018] [Accepted: 04/14/2018] [Indexed: 12/16/2022]
Abstract
The effects of diabetes and diabetes therapy on bone are less known among clinicians. Traditionally, the emphasis of diabetes therapy has been on reducing cardiovascular risk by facilitating reductions in weight, blood pressure, blood sugar, systemic inflammation, and lipid levels. Now, with ample research demonstrating that patients with diabetes are more susceptible to bone fractures relative to controls, there has been a greater or renewed interest in studying the effects of diabetes therapy on bone. Interestingly, the majority of antidiabetic agents positively affect bone, but a few have detrimental effects. Specifically, although insulin has been demonstrated to be anabolic to bone, the rate of hypoglycemic episodes are increased with exogenous infusion; consequently, there is an increased fall and fracture frequency. Other agents such as thiazolidinediones have more direct negative effects on bone through transcriptional regulation. Even metabolic surgery, to a varying operation-dependent extent, exacerbates bone strength and may heighten fracture rate. The remaining diabetes agents seem to have neutral or positive effects on bone. With the increasing incidence of diabetes, it is more pertinent than ever to fully comprehend the effects of diabetes-related therapeutic modalities.
Collapse
MESH Headings
- Bone Density/drug effects
- Bone Diseases, Metabolic/etiology
- Bone Diseases, Metabolic/pathology
- Bone Diseases, Metabolic/prevention & control
- Bone and Bones/drug effects
- Bone and Bones/physiology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Fractures, Bone/etiology
- Fractures, Bone/pathology
- Humans
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Osteoporosis/etiology
- Osteoporosis/metabolism
- Osteoporosis/pathology
- Risk Factors
Collapse
Affiliation(s)
- Karim G Kheniser
- Department of Endocrinology and Metabolism, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Carmen M Polanco Santos
- Department of Endocrinology and Metabolism, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Sangeeta R Kashyap
- Department of Endocrinology and Metabolism, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| |
Collapse
|
43
|
Barazzoni R, Bischoff SC, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic obesity: Time to meet the challenge. Clin Nutr 2018; 37:1787-1793. [PMID: 29857921 DOI: 10.1016/j.clnu.2018.04.018] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 01/01/2023]
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
Collapse
Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Stephan C Bischoff
- University of Hohenheim, Department of Nutritional Medicine, Stuttgart, Germany
| | - Yves Boirie
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Service Nutrition Clinique, F-63000 Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Uppsala University, Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| |
Collapse
|
44
|
Sans A, Bailly L, Anty R, Sielezenef I, Gugenheim J, Tran A, Gual P, Iannelli A. Baseline Anthropometric and Metabolic Parameters Correlate with Weight Loss in Women 1-Year After Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2018; 27:2940-2949. [PMID: 28550439 DOI: 10.1007/s11695-017-2720-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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 ).
Collapse
Affiliation(s)
- Arnaud Sans
- Department of Digestive Surgery, CHU Timone, Marseille, France.,INSERM UMR-S1076, VRCM, Aix Marseille University, Marseille, France
| | - Laurent Bailly
- Université Côte d'Azur, LAMHESS, Nice, France.,Département de santé publique, CHU de Nice, Nice, France
| | - Rodolphe Anty
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Igor Sielezenef
- Department of Digestive Surgery, CHU Timone, Marseille, France.,INSERM UMR-S1076, VRCM, Aix Marseille University, Marseille, France
| | - Jean Gugenheim
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Albert Tran
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Philippe Gual
- Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France. .,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France. .,University of Nice Sophia-Antipolis, 06107, Nice, France. .,Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, Cedex 3, France.
| |
Collapse
|
45
|
Sherf Dagan S, Keidar A, Raziel A, Sakran N, Goitein D, Shibolet O, Zelber-Sagi S. Do Bariatric Patients Follow Dietary and Lifestyle Recommendations during the First Postoperative Year? Obes Surg 2018; 27:2258-2271. [PMID: 28303504 DOI: 10.1007/s11695-017-2633-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. METHODS A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. RESULTS Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m2). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%) as recommended. PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 (P ≤ 0.044). Most of the patients adhered to the recommended supplementation at all time points (≥57.1%). Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid, iron, hemoglobin, and vitamins D and B12 (P ≤ 0.056 for all). Adherence to all recommendations was not significantly associated with excess weight loss ≥60% at M12 (P ≥ 0.195 for all). CONCLUSION Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG; however, adherence to those recommendations was not related to better weight loss at short-term follow-up. Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively.
Collapse
Affiliation(s)
- Shiri Sherf Dagan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Assuta Medical Center, Tel-Aviv, Israel.
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel.
| | - Andrei Keidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | | | - Nasser Sakran
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - David Goitein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
| | - Shira Zelber-Sagi
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
46
|
Ben-Porat T, Elazary R, Sherf-Dagan S, Goldenshluger A, Brodie R, Mintz Y, Weiss R. Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss. Adv Nutr 2018; 9:114-127. [PMID: 29659692 PMCID: PMC5916426 DOI: 10.1093/advances/nmx024] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery (BS) is an effective treatment for morbid obesity and its associated comorbidities. Following such a procedure, however, patients are at risk of developing metabolic bone disease owing to the combination of rapid weight loss, severely restricted dietary intake, and reduced intestinal nutrient absorption. Patients undergoing malabsorptive procedures are at a higher risk of postoperative bone health deterioration than those undergoing restrictive procedures; however, studies have demonstrated negative skeletal consequences of restrictive procedures as well. The clinical practice guidelines of some international associations have previously addressed preoperative evaluation and postoperative clinical care in order to maintain bone health in BS patients. Nevertheless, some issues regarding bone health in BS patients remain unclear owing to the lack of relevant randomized clinical trials, including doses of nutritional supplements pre- and post-BS. This review summarizes the current data regarding the skeletal consequences of BS and its mechanisms, with an emphasis on the preventive strategies and nutritional care that may be warranted in order to attenuate bone deterioration following BS.
Collapse
Affiliation(s)
- Tair Ben-Porat
- Departments of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Hebrew University, Jerusalem, Israel
| | - Ram Elazary
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ariela Goldenshluger
- Departments of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronit Brodie
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Weiss
- Department of Human Metabolism and Nutrition, Hebrew University, Jerusalem, Israel
| |
Collapse
|
47
|
Steenackers N, Gesquiere I, Matthys C. The relevance of dietary protein after bariatric surgery: what do we know? Curr Opin Clin Nutr Metab Care 2018; 21:58-63. [PMID: 29035973 DOI: 10.1097/mco.0000000000000437] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The growing obesity epidemic is associated with an increased demand for bariatric surgery with Roux-en-Y Gastric Bypass and Sleeve Gastrectomy as the most widely performed procedures. Despite beneficial consequences, nutritional complications may arise because of anatomical and physiological changes of the gastrointestinal tract. The purpose of this review is to provide an update of the recent additions to our understanding of the impact of bariatric surgery on the intake, digestion and absorption of dietary protein. RECENT FINDINGS After bariatric surgery, protein intake is compromised because of reduced gastric capacity and aversion for certain foods. A minority of patients reaches the recommended protein intake of minimal 60 g per day, which results in the loss of fat-free mass rather than the desired loss of fat mass. Despite inadequate protein intake, protein digestion and absorption do not seem to be impaired suggesting that other mechanisms could counteract the reduced secretion of digestive enzymes and their delayed inlet. SUMMARY After bariatric surgery, protein supplementation or diet enrichment could attribute to achieve the minimal recommended protein intake and benefit the amount and composition of postoperative weight loss.
Collapse
|
48
|
Barazzoni R, Bischoff S, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic Obesity: Time to Meet the Challenge. Obes Facts 2018; 11:294-305. [PMID: 30016792 PMCID: PMC6189532 DOI: 10.1159/000490361] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social, and multidisciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures, and cancer as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability, and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term 'sarcopenic obesity' has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification, and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria, and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has a strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
Collapse
Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
- *Rocco Barazzoni, MD, PhD, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy,
| | - Stephan Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont-Ferrand, France
- Service Nutrition Clinique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| |
Collapse
|
49
|
Ito MK, Gonçalves VSS, Faria SLCM, Moizé V, Porporatti AL, Guerra ENS, De Luca Canto G, de Carvalho KMB. Effect of Protein Intake on the Protein Status and Lean Mass of Post-Bariatric Surgery Patients: a Systematic Review. Obes Surg 2017; 27:502-512. [PMID: 27844254 DOI: 10.1007/s11695-016-2453-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Post-bariatric surgery may compromise nutritional status due to energy and protein intake restriction. METHODS Systematic review was performed to synthesize evidence on the amount of protein intake and its association with lean mass and serum proteins during at least 6 months following Roux-en-Y gastric bypass or sleeve gastrectomy. RESULTS Twelve studies (n = 739) were identified in the search. Protein intake below 60 g/day and significant lean mass loss were observed in majority of these studies. Of the four studies that measured association between protein intake and lean mass retention, only two supported this hypothesis. CONCLUSION There is insufficient evidence of the effect of dietary protein on serum protein levels. Further studies are needed to better estimate the protein intake that supports a healthy nutritional status in this population.
Collapse
Affiliation(s)
- Marina Kiyomi Ito
- Department of Nutrition, Graduate Program in Human Nutrition, University of Brasilia, Brasilia, DF, Brazil
| | | | - Silvia Leite Campos Martins Faria
- Department of Nutrition, Graduate Program in Human Nutrition, University of Brasilia, Brasilia, DF, Brazil. .,Gastrocirurgia de Brasilia, Brasilia, DF, Brazil.
| | - Violeta Moizé
- Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain
| | - André Luís Porporatti
- Brazilian Centre for Evidence-based Research, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Science Faculty, University of Brasilia, Brasília, DF, Brazil
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-based Research, Federal University of Santa Catarina, Florianopolis, Brazil
| | | |
Collapse
|
50
|
Schiavo L, Scalera G, Pilone V, De Sena G, Quagliariello V, Iannelli A, Barbarisi A. A Comparative Study Examining the Impact of a Protein-Enriched Vs Normal Protein Postoperative Diet on Body Composition and Resting Metabolic Rate in Obese Patients after Sleeve Gastrectomy. Obes Surg 2017; 27:881-888. [PMID: 27677487 DOI: 10.1007/s11695-016-2382-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We recently showed that an 8-week preoperative protein-enriched diet (PED) is associated with significant reductions in body weight and fat mass (FM) without significant loss of fat-free mass (FFM) in morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG). OBJECTIVES The objective of this study is to evaluate the impact of PED vs a normal protein diet (NPD) on total weight loss (TWL), FM, FFM, and resting metabolic rate (RMR) in patients after LSG. METHODS Before LSG and at 3, 6, and 12 months after, we prospectively measured and compared total body weight (TBW), FM, FFM, and RMR in 60 male patients who received either a NPD (n = 30) with protein intake 1.0 g/kg of ideal body weight, or a PED (n = 30) with protein intake 2.0 g/kg of ideal body weight. Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of NPD and PED on renal function was also evaluated. RESULTS Despite non-significant variation in total body weight (TBW), FM decreased more significantly (p < 0.01) with the PED compared to the NPD. In addition, the PED group showed a significantly (p < 0.01) lower decrease in FFM and RMR when compared with the NPD group. Both groups showed high compliance in following the prescribed diets, without negative impact on renal function. CONCLUSION PED is more effective than NPD in determining FM loss and is associated with a lower decrease in FFM and RMR, without interfering with renal function in male patients after LSG.
Collapse
Affiliation(s)
- Luigi Schiavo
- Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy.
| | - Giuseppe Scalera
- Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy
| | - Vincenzo Pilone
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Gabriele De Sena
- Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy
| | - Vincenzo Quagliariello
- Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Alfonso Barbarisi
- Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy
| |
Collapse
|