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Harbury C, Shrewsbury VA, Collins CE, Callister R. Feasibility and preliminary efficacy of an online nutrition education intervention for those with a sleeve gastrectomy: A pilot randomised control trial. J Hum Nutr Diet 2024. [PMID: 39004917 DOI: 10.1111/jhn.13348] [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: 01/09/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND A sleeve gastrectomy (SG) is a lifelong treatment that improves health and better outcomes are associated with follow-up. However, there is lack of access or high attrition to aftercare. This potentially contributes to sub-optimal dietary intake and a lack of evidence for nutrition interventions. The present study assessed the feasibility and preliminary efficacy of a nutrition intervention to improve diet quality in Australian adults living with a SG. METHODS Adults (n = 96) post-SG were recruited into a cross-sectional diet quality study, with 68 eligible for randomisation to an intervention or wait-list control group. Over 10 weeks, a Facebook group was used to post daily nutrition education. Feasibility outcomes included participant recruitment, engagement, retention and acceptability. Preliminary efficacy was assessed using change in Australian Recommended Food Score (ARFS). Linear mixed models were used to measure differences in mean outcome between the experimental groups over time. RESULTS Sixty-eight participants (97% female) aged 48.2 ± 9.8 years, body mass index 33.1 ± 5.8 kg/m2, and mean ± SD ARFS 39 ± 9 points were randomised to the intervention, with 66% retention at 10 weeks. At follow-up, diet quality increased for the intervention group (mean ARFS, 95% confidence interval = 0.2 [-1.5 to 1.9]) and decreased for the control group (mean ARFS, 95% confidence interval= -2.0 [-5.2 to 1.2]) with no between group difference (p = 0.2). Participants (n = 30) rated the intervention positively. CONCLUSIONS Recruiting and retaining adults post-SG into a nutrition intervention is feasible. Low-cost recruitment attracted strong interest from women to identify greater support to know what to eat following SG. A future fully powered trial to assess intervention efficacy is warranted.
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Affiliation(s)
- Cathy Harbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robin Callister
- School of Biomedical Science and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Khee GY, Lim PS, Chan YL, Lee PC. Collaborative Prescribing Practice in Managing Patients Post-Bariatric Surgery in a Tertiary Centre in Singapore. PHARMACY 2024; 12:31. [PMID: 38392938 PMCID: PMC10893196 DOI: 10.3390/pharmacy12010031] [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: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient's weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery.
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Affiliation(s)
- Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
| | - Paik Shia Lim
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
| | - Yoke Ling Chan
- Department of Speciality Nursing, Singapore General Hospital, Singapore 169608, Singapore;
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore;
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Ibrahim T, El Ansari W, Abusabeib A, Yousaf Z, Elhag W. Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery. Surg Obes Relat Dis 2024; 20:115-126. [PMID: 37620168 DOI: 10.1016/j.soard.2023.06.013] [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: 02/07/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed. OBJECTIVE We assessed TD among adolescents following MBS. SETTING University Hospital. METHODS A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD. RESULTS Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Associated factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A. CONCLUSIONS This is the first in-depth study of TD among adolescents after MBS. Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up.
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Affiliation(s)
- Tawheeda Ibrahim
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Alyaa Abusabeib
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar
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Rossini G, Risi R, Monte L, Sancetta B, Quadrini M, Ugoccioni M, Masi D, Rossetti R, D'Alessio R, Mazzilli R, Defeudis G, Lubrano C, Gnessi L, Watanabe M, Manfrini S, Tuccinardi D. Postbariatric surgery hypoglycemia: Nutritional, pharmacological and surgical perspectives. Diabetes Metab Res Rev 2024; 40:e3750. [PMID: 38018334 DOI: 10.1002/dmrr.3750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery (BS), consisting of low post-prandial glucose levels in patients having undergone bariatric procedures. While BS is currently the most effective and relatively safe treatment for obesity and its complications, the development of PBH can significantly impact patients' quality of life and mental health. The diagnosis of PBH is still challenging, considering the lack of definitive and reliable diagnostic tools, and the fact that this condition is frequently asymptomatic. However, PBH's prevalence is alarming, involving up to 88% of the post-bariatric population, depending on the diagnostic tool, and this may be underestimated. Given the prevalence of obesity soaring, and an increasing number of bariatric procedures being performed, it is crucial that physicians are skilled to diagnose PBH and promptly treat patients suffering from it. While the milestone of managing this condition is nutritional therapy, growing evidence suggests that old and new pharmacological approaches may be adopted as adjunct therapies for managing this complex condition.
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Affiliation(s)
- Giovanni Rossini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Renata Risi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lavinia Monte
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Biagio Sancetta
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Maria Quadrini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimiliano Ugoccioni
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Davide Masi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rebecca Rossetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Rossella Mazzilli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Defeudis
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Mikiko Watanabe
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvia Manfrini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Dario Tuccinardi
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
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López-Gómez JJ, Ramos-Bachiller B, Primo-Martín D, Calleja-Fernández A, Izaola-Jauregui O, Jiménez-Sahagún R, González-Gutiérrez J, López Andrés E, Pinto-Fuentes P, Pacheco-Sánchez D, De Luis-Román DA. Effect on Body Composition of a Meal-Replacement Progression Diet in Patients 1 Month after Bariatric Surgery. Nutrients 2023; 16:106. [PMID: 38201936 PMCID: PMC10780820 DOI: 10.3390/nu16010106] [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: 11/30/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Progression diets after bariatric surgery (BS) are restricted in calories and protein, and they may induce a worsening of body composition. The aim of this study was to evaluate the effect of a modified diet with an oral nutritional supplement that is hyperproteic and normocaloric over the body composition. METHODS A two-arm ambispective observational cohort study was designed. Forty-four patients who underwent sleeve gastrectomy were included in the study. Thirty patients received a progression diet with a normocaloric, hyperproteic oral nutritional supplement during the first two weeks after surgery (820 kcal, 65.5 g protein). They were compared with a historical cohort of 14 patients treated with a standard progression diet (220 kcal, 11.5 g protein). Anthropometric and body composition (using electrical bioimpedanciometry) data were analyzed before BS and 1 month after the surgery. RESULTS The mean age was 47.35(10.22) years; 75% were women, and the average presurgical body mass index (BMI) was 45.98(6.13) kg/m2, with no differences between both arms of intervention. One month after surgery, no differences in the percentage of excess weight loss (%PEWL) were observed between patients in the high-protein-diet group (HP) and low-protein-diet group (LP) (HP: 21.86 (12.60)%; LP: 18.10 (13.49)%; p = 0.38). A lower loss of appendicular skeletal muscle mass index was observed in the HP (HP: -5.70 (8.79)%; LP: -10.54 (6.29)%; p < 0.05) and fat-free mass index (HP: 3.86 (8.50)%; LP:-9.44 (5.75)%; p = 0.03), while a higher loss of fat mass was observed in the HP (HP: -14.22 (10.09)%; LP: -5.26 (11.08)%; p < 0.01). CONCLUSIONS In patients undergoing gastric sleeve surgery, the addition of a normocaloric, hyperproteic formula managed to slow down the loss of muscle mass and increase the loss of fat mass with no differences on total weight loss.
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Affiliation(s)
- Juan J. López-Gómez
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Beatriz Ramos-Bachiller
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - David Primo-Martín
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Alicia Calleja-Fernández
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Rebeca Jiménez-Sahagún
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Jaime González-Gutiérrez
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Eva López Andrés
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Pilar Pinto-Fuentes
- General Surgery Department, Rio Hortega Universitary Hospital, 47012 Valladolid, Spain
| | - David Pacheco-Sánchez
- General Surgery Department, Rio Hortega Universitary Hospital, 47012 Valladolid, Spain
| | - Daniel A. De Luis-Román
- Endocrinology and Nutrition Department, Clinic Universitary Hospital of Valladolid, 47003 Valladolid, Spain
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
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Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post bariatric Surgery-an Australian Experience. Obes Surg 2023; 33:3437-3446. [PMID: 37773088 PMCID: PMC10602995 DOI: 10.1007/s11695-023-06822-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: 02/27/2023] [Revised: 08/19/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Bariatric surgery predisposes patients to nutritional deficiencies. There are limited studies on zinc and copper abnormalities in this cohort. PURPOSE The aim of this study was to identify the prevalence of these abnormalities in a cohort of Australian bariatric patients. Inflammatory markers, adherence to multivitamin supplementation (MVS) and the presence of gastrointestinal (GI) symptoms were also investigated. MATERIAL AND METHODS Data was collected on all patients who attended a single clinic in Sydney, Australia, from August 2020 to August 2021. RESULTS The study cohort consisted of 231 patients (76.2% female; mean pre-operative body mass index of 43.4 ± 7.1 kg/m2), most of whom underwent sleeve gastrectomy (78.8%). Data were collected preoperatively and then at ≤ 6 months, 1 and > 2 years postoperatively. Prior to surgery, low levels of zinc (2.1%) and copper (0.7%) were rare, but elevated copper levels were common (16.7%) and potentially related to an elevated C-reactive protein (CRP) (47.7%). Following surgery at > 2 years, the mean total weight loss (TWL) was 33.5 ± 12.4. CRP levels improved over time. Post operatively, low zinc (2.7-3.6%) and copper (1.5%) levels were rare. Patients with low levels in zinc and copper were a higher-risk group and generally exhibited GI symptoms, despite taking MVS. CONCLUSION In the initial post-operative stages and with good adherence to MVS containing copper and zinc, abnormalities may not be a concern. Patients with GI symptoms appear to be at higher risk of abnormalities; increasing awareness, thorough screening, and more comprehensive supplementation are recommended.
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Affiliation(s)
- Nazy Zarshenas
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Shore Surgical, 156-158 Pacific Highway, Greenwhich, Sydney, NSW, 2065, Australia.
| | - Linda C Tapsell
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Michael L Talbot
- St George and Sutherland Clinical School, St George Private Hospital, Suite 3 Level 5 1 South St, Kogarah, Sydney, NSW, 2217, Australia
- University of New South Wales, Sydney, Australia
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Parzer V, Resl M, Stechemesser L, Wakolbinger M, Itariu B, Brix JM. [Postoperative management]. Wien Klin Wochenschr 2023; 135:729-742. [PMID: 37821696 PMCID: PMC10567962 DOI: 10.1007/s00508-023-02272-7] [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] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Bariatric surgery results in significant weight loss, reduction or even remission of obesity-associated comorbidities, reduced mortality, and improved quality of life in many patients; however, obesity is a chronic disease, thus follow-up care is required after bariatric surgery. Furthermore, specific issues, such as micronutrient deficiencies and subsequent complications, can arise both in the short-term and the long-term. Abdominal pain after bariatric surgery must always be regarded as a serious symptom. A further focus should be on the diagnosis and treatment of dumping syndrome. Patients with type 2 diabetes should be regularly screened for recurrent hyperglycemia as well as specific sequelae, even though blood glucose levels may be substantially improved or normalized. In addition to centers with multidisciplinary teams, primary care and, in particular, general practitioners will play an increasingly more important role in the follow-up care after bariatric surgery.
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Affiliation(s)
- Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Michael Resl
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Bianca Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
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Aguas-Ayesa M, Yárnoz-Esquíroz P, Olazarán L, Gómez-Ambrosi J, Frühbeck G. Precision nutrition in the context of bariatric surgery. Rev Endocr Metab Disord 2023; 24:979-991. [PMID: 36928810 PMCID: PMC10020075 DOI: 10.1007/s11154-023-09794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.
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Affiliation(s)
- Maite Aguas-Ayesa
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
| | - Patricia Yárnoz-Esquíroz
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Laura Olazarán
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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Zefreh H, Amani-Beni R, Sheikhbahaei E, Farsi F, Ahmadkaraji S, Barzin M, Darouei B, Khalaj A, Shahabi S. What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery. Int J Endocrinol Metab 2023; 21:e136329. [PMID: 38666043 PMCID: PMC11041817 DOI: 10.5812/ijem-136329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 04/28/2024] Open
Abstract
Context This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.
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Affiliation(s)
- Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ahmadkaraji
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Darouei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khalaj
- Department of Surgery, School of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Furtado MM. Comment on: Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis 2023; 19:943-944. [PMID: 37117084 DOI: 10.1016/j.soard.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 04/30/2023]
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Mathews AL, Shah RM, Sweigert PJ, Zuro L, Mahoney K, Flaherty F, Chand B. Patient perspectives on post-bariatric surgery nutritional supplementation. Surg Endosc 2023:10.1007/s00464-023-09994-9. [PMID: 37311895 DOI: 10.1007/s00464-023-09994-9] [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: 05/03/2021] [Accepted: 02/23/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bariatric procedures increase patient risk of long-term metabolic complications primarily due to nutrient deficiencies. The mainstay of prevention includes routine vitamin and mineral supplementation; however, patient-reported barriers to daily compliance are poorly understood. METHODS Post-bariatric surgery patients electively participated in an 11-point outpatient survey at a single academic institution. Surgical procedures included either laparoscopic sleeve gastrectomy (SG) or gastric bypass (GB). At the time of survey, patients ranged from 1-month to 15 years from surgery. Survey items consisted of dichotomous (yes/no), multiple choice, and open-ended free response questions. Descriptive statistics were evaluated. RESULTS Two hundred and fourteen responses were collected, 116 (54%) underwent SG and 98 (46%) underwent GB. Of these, 49% of samples were during short-term postoperative follow-up visits (0-3 months), 34% intermediate follow-up (4-12 months), and 17% long-term follow-up (> 1 year). A total of 98% of patients reported that insurance did not cover their supplement cost. Most patients reported current vitamin use (95%), with 87% reporting daily compliance. Daily compliance was observed in 94%, 79%, and 73% of SG patients at short-, intermediate-, and long-term follow-up visits, respectively. While GB patients reported daily compliance in 84%, 100%, and 92% of short, intermediate, and long-term responses. Of those who were unable to take vitamins daily, non-compliance was attributed most to forgetting (54%), and less often to side effects (11%), or taste (11%). Patient-reported strategies for remembering to take vitamins included tying into daily routine (55%), use of a pill box (7%), and alarm reminders (7%). CONCLUSIONS Daily compliance with post-bariatric surgery vitamin supplementation does not appear to vary based on postoperative time-period or surgical procedure. While a minority of patients struggle with daily compliance, factors associated with non-compliance include patient forgetting, side effects, and taste. Widespread utilization of patient-reported daily reminder strategies may lead to improved overall compliance and reduce incidence of nutritional deficiencies.
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Affiliation(s)
| | | | - Patrick J Sweigert
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Zuro
- Department of Surgery, Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA
| | - Kimberly Mahoney
- Department of Surgery, Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA
| | - Faith Flaherty
- Department of Surgery, Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA
| | - Bipan Chand
- Department of Surgery, Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 S. First Ave, Maywood, IL, 60153, USA.
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Sá CMATD, Burgos MGPDA, Rabelo Filho LV, Calado CKM, Costa MDC, Silva TCDA, Vieira RAL, Cabral PC. BODY COMPOSITION ASSESSED BY DUAL-ENERGY X-RAY ABSORPTIOMETRY ON METABOLIC PROFILE AND CARDIOVASCULAR RISK IN OBESE PATIENTS PRIOR TO BARIATRIC SURGERY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1734. [PMID: 37255103 DOI: 10.1590/0102-672020230016e1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/10/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fat, muscle, and bone are endocrine organs capable of affecting the metabolic profile and cardiovascular risk. Relating these components is important to the establishment of early intervention strategies for overweight patients. AIMS This study aimed to evaluate the influence of body mass components on the metabolic profile and cardiovascular risk in the preoperative period of bariatric surgery. METHODS A cross-sectional study was conducted with patients admitted for bariatric surgery at a university hospital in the city of Recife, Brazil, between 2018 and 2019. Body composition was determined using dual-energy x-ray absorptiometry. Cardiovascular risk was assessed using the Framingham risk score. Data were collected on anthropometric, clinical, and lifestyle characteristics. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides), blood glucose, and vitamin D were determined using the standard methods of the hospital laboratory. RESULTS A total of 60 patients were analyzed, 86.7% of whom had comorbidities, 33.3% had moderate/high cardiovascular risk, and 71.4% had vitamin D insufficiency/deficiency. Lower lean body mass (adjusted PR 3.24; 95%CI 1.19-5.77) was independently associated with the severity of obesity. The body mass index and waist circumference were negatively correlated with lean body mass (r=-0.52; p<0.01)/r=-0.36; p<0.01). Lean body mass was negatively correlated with fat mass (r=-0.26; p<0.05), trunk fat (r=-0.29; p<0.05), fasting glucose (r=-0.26; p<0.05), and bone mineral density (r=-0.26; p<0.05). A total of 84.2% of individuals with less trunk fat tended to have low cardiovascular risk (p=0.05). However, physical inactivity (adjusted PR 2.14; 95%CI 1.19-5.54) and the risk of alcohol dependence (adjusted PR 2.41; 95%CI 1.76-4.15) were the only variables independently associated with cardiovascular risk. CONCLUSION Obese patients in the preoperative period of bariatric surgery with less trunk fat tended to have low cardiovascular risk. However, the other components of body mass were also not associated with cardiovascular risk.
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Translation and Validation of the Arabic Version of the Eating Behavior After Bariatric Surgery (EBBS) Questionnaire. Obes Surg 2023; 33:1108-1120. [PMID: 36781595 PMCID: PMC10079758 DOI: 10.1007/s11695-023-06480-y] [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: 11/21/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Complications after metabolic and bariatric surgery are common due to the patient's poor commitment to postoperative lifestyle changes. Therefore, intensive follow-up from a multidisciplinary team might improve outcomes. The present study aimed to translate and validate the Eating Behavior after Bariatric Surgery (EBBS) questionnaire into Arabic for use in clinical and research settings. MATERIALS AND METHODS The study followed World Health Organization guidelines for translation and questionnaire adaptation, including forward translation, back translation, pilot testing, and the creation of the final version of the tool. A total of 390 patients who had undergone metabolic and bariatric surgery 3 years ago or more were involved in testing the questionnaire's validity and reliability. RESULTS The mean age of participants was 36 years (range: 20 to 70 years), 56% were females, 94.1% were Saudis, and 56% had bachelor's degrees. The internal consistency of the questionnaire was tested using Cronbach's alpha. One item (alcohol consumption) was excluded during the reliability analysis due to low variance. The reliability analysis results showed that the 10 items were internally consistent, with a Cronbach's α of 0.851. CONCLUSION The validation and reliability of the Arabic-language version of the EBBS questionnaire were found to be satisfactory. The presence of a validated Arabic version of this instrument may help practitioners estimate patients' adherence to dietary and lifestyle recommendations after metabolic and bariatric surgery. Furthermore, the questionnaire may aid in identifying factors that influence the efficacy of these procedures.
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González-Sánchez DL, Murillo-Prado BR, Zaragoza-Calderón CM, Armenta-Rojas E, Cornejo-Bravo JM, Andrade-Soto VH, Pineda-García G, Serrano-Medina A. Micronutrient Deficiency Pre- and Post-bariatric Metabolic Surgery in Latin America: a Systematic Review. Obes Surg 2023; 33:635-664. [PMID: 36571582 DOI: 10.1007/s11695-022-06424-y] [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: 07/23/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Persons submitted to bariatric metabolic surgery present micronutrient deficiency before and after surgery, due to the lack of proper supplementation. The aim of this study is to establish the prevalence of micronutrient deficiency in people before and after bariatric metabolic surgery in Latin America. METHODS This review was conducted in accordance with the 2020 PRISMA Guidelines. RESULTS Twenty-seven studies and 2135 participants were included. The highest prevalence of deficiency before surgery was reported for vitamin D (74%), zinc (71%), and hemoglobin (62%); after surgery, they were vitamin A (90.6%), vitamin D (90%), and zinc (68%). CONCLUSIONS There is a high prevalence of micronutrient deficiency before and after bariatric metabolic surgery from Latin American persons; the micronutrients with the highest deficiency prevalence were vitamin D before and vitamin A after bariatric metabolic surgery.
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Affiliation(s)
- Daniela L González-Sánchez
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - Brian R Murillo-Prado
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - Claudia M Zaragoza-Calderón
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - Efraín Armenta-Rojas
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - José M Cornejo-Bravo
- Chemical Sciences and Engineering Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - Víctor H Andrade-Soto
- Health Sciences Faculty, Autonomous University of Baja California, Blvd Universitario, 1000 Valle de Las Palmas, 22260, Tijuana, Mexico
| | - Gisela Pineda-García
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico
| | - Aracely Serrano-Medina
- Medicine and Psychology Faculty, Autonomous University of Baja California, Calzada Universidad 14418, Parque Industrial Internacional 22300, Tijuana, Mexico.
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Usual dietary intake, physical activity, weight loss, and body composition after five years of Roux-en-Y gastric bypass. Int J Obes (Lond) 2023; 47:263-272. [PMID: 36690843 DOI: 10.1038/s41366-023-01256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To estimate usual dietary intake (UDI), physical activity (PA), and their association with weight loss and body composition in patients who underwent Roux-en-Y gastric bypass (RYGB) after five years in the Federal District, Brazil. METHODS We assessed anthropometry and body composition using bioimpedance, and dietary intake and PA with three nonconsecutive 24-h recalls. PC-Side was used to estimate UDI. Dietary patterns (DPs) were identified through principal component analysis, and association between UDI and PA with percentage of total weight loss (%TWL) and fat-free mass (FFM) through multinomial logistic regression. RESULTS Sample (n = 124) presented mean (SD) age of 48.9 (9.4) years, median (IQR) of 9 years (7-10) post RYGB, current BMI = 32.3 kg/m² (28.8-35.7), %TWL = 24.7% (10.9), and FFM = 45.1 kg (41.1-51.9). Mean usual energy intake of 1556 kcal/d, with adequate protein intake, poor fiber intake, and excessive carbohydrate, total fat, and added sugar intake, compared to dietary guidelines. Calcium, vitamins C, D, and E presented the greatest inadequacy (15%, 24%, 32%, and 49% of individuals, respectively, reported usual intake below EAR); 83 participants were considered active/very active, according PA. DP with high energy, protein, total fat, saturated fat, and sodium intake, was negatively associated with %TWL (OR = 0.545, p = 0.037). Protein intake was positively associated with FFM (OR = 1.091, p = 0.004). PA was not associated with %TWL or FFM. CONCLUSION Participants demonstrated intake of carbohydrate, fat, fiber, added sugar not in accordance with guidelines. A DP rich in energy, protein, total fat, saturated fat, and sodium appears to decrease TWL. However, protein intake appears to increase FFM.
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Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Investigating the prevalence of nutritional abnormalities in patients prior to and following bariatric surgery. Nutr Diet 2022; 79:590-601. [PMID: 35746865 PMCID: PMC9796270 DOI: 10.1111/1747-0080.12747] [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: 02/03/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 01/01/2023]
Abstract
AIMS Bariatric surgery remains an effective treatment for the condition of obesity. However it predisposes patients to nutritional deficiencies and related complications. The aim of this study was to identify nutritional abnormalities, weight loss, adherence to supplements, and presence of gastrointestinal symptoms in a cohort of bariatric surgical patients. METHODS An analysis of the electronic medical records of patients attending a multidisciplinary private clinic in Sydney, Australia from August 2020 to August 2021 was conducted. Data on anthropometric measures, nutritional indices, adherence to supplements and gastrointestinal symptoms preoperatively and then at ≤6 months, 1 and 2 years or more postoperatively were collected. RESULTS A total of 231 patients were included in the study. The majority of patients were female (76.2%), with a sleeve gastrectomy (78.8%). Average preoperative BMI was 43.4 ± 7.1 kg/m2 . Weight loss ≥2 years postsurgery was 33.5 ± 12.4 kg. The most common abnormalities preoperatively were: C-reactive protein (47.7%), vitamin D (39%), B12 (31%), parathyroid hormone (27.6%) and ferritin (12.7%). Vitamin B12 (23.2%), parathyroid hormone (23%), vitamin D (17.7%) and ferritin (15.9%) remained common abnormalities postoperatively. Adherence to multivitamins was 90% in the first year following surgery, declining to 77% at ≥2 years. Gastrointestinal symptoms were predominantly present in the initial stages following surgery, manifesting thiamin deficiency in 6.5% of patients. CONCLUSIONS Despite achieving durable weight loss, nutritional and related abnormalities remain an ongoing challenge for bariatric surgery. Adherence to nutrient supplements, gastrointestinal symptoms and related complications are important considerations in addressing the problem.
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Affiliation(s)
- Nazy Zarshenas
- Faculty of Science, Medicine and Health, School of MedicineUniversity of WollongongWollongongNew South WalesAustralia,Shore SurgicalGreenwichNew South WalesAustralia
| | - Linda Clare Tapsell
- Faculty of Science, Medicine and Health, School of MedicineUniversity of WollongongWollongongNew South WalesAustralia
| | - Marijka Batterham
- Faculty of Engineering and Information Sciences, School of Mathematics and Applied StatisticsUniversity of WollongongWollongongNew South WalesAustralia
| | - Elizabeth Phillipa Neale
- Faculty of Science, Medicine and Health, School of MedicineUniversity of WollongongWollongongNew South WalesAustralia
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Sarno G, Schiavo L, Calabrese P, Álvarez Córdova L, Frias-Toral E, Cucalón G, Garcia-Velasquez E, Fuchs-Tarlovsky V, Pilone V. The Impact of Bariatric-Surgery-Induced Weight Loss on Patients Undergoing Liver Transplant: A Focus on Metabolism, Pathophysiological Changes, and Outcome in Obese Patients Suffering NAFLD-Related Cirrhosis. J Clin Med 2022; 11:jcm11185293. [PMID: 36142939 PMCID: PMC9503676 DOI: 10.3390/jcm11185293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Because of their condition, patients with morbid obesity develop several histopathological changes in the liver, such as non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), cirrhosis, and end-stage liver disease (ESLD). Hence, a liver transplant (LT) becomes an opportune solution for them. Due to many challenges during the perioperative and postoperative periods, these patients are recommended to lose weight before the surgery. There are many proposals to achieve this goal, such as intragastric balloons and many different bariatric surgery (BS) procedures in combination with a preparation diet (very-low-calorie diet, ketogenic diet, etc.). All the interventions focus on losing weight and keeping the continuity and functionality of the digestive tract to avoid postoperative complications. Thus, this review analyzes recent publications regarding the metabolic and pathophysiological impacts of BS in LT patients suffering from NAFLD-related cirrhosis, the effect of weight loss on postoperative complications, and exposes the cost-effectiveness of performing BS before, after, and at liver transplantation. Finally, the authors recommend BS before the LT since there are many positive effects and better outcomes for patients who lose weight before the procedure. Nevertheless, further multicentric studies are needed to determine the generalizability of these recommendations due to their impact on public health.
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Affiliation(s)
- Gerardo Sarno
- San Giovanni di Dio e Ruggi D’Aragona University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Luigi Schiavo
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, P.O. Gaetano Fucito Mercato San Severino, 84085 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy
- Correspondence: ; Tel.: +39-089-965062
| | - Pietro Calabrese
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, P.O. Gaetano Fucito Mercato San Severino, 84085 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy
| | - Ludwig Álvarez Córdova
- Carrera de Nutrición y Dietética, Facultad de Ciencias Médicas, Universidad Católica De Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
- Universidad de Especialidades Espìritu Santo, Samborondòn 0901952, Ecuador
| | - Gabriela Cucalón
- Lifescience Faculty, ESPOL Polytechnic University, Escuela Superior Politécnica del Litoral (ESPOL), Campus Gustavo Galindo Km. 30.5 Vía Perimetral, Guayaquil 090615, Ecuador
| | | | | | - Vincenzo Pilone
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, P.O. Gaetano Fucito Mercato San Severino, 84085 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy
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KOMAEI I, CURRÒ G, SARRA F, GUCCIONE F, DAMIANO C, IDONE A, ROSI F, GIOFFRE A, DE PASQUALE G, AMMENDOLA M, NAVARRA G. Liquid tolerance following laparoscopic sleeve gastrectomy: Long-term results of a single bariatric center. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Markovic TP, Proietto J, Dixon JB, Rigas G, Deed G, Hamdorf JM, Bessell E, Kizirian N, Andrikopoulos S, Colagiuri S. The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care. Obes Res Clin Pract 2022; 16:353-363. [PMID: 36050266 DOI: 10.1016/j.orcp.2022.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/02/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Obesity is a complex and multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, metabolic associated fatty liver disease, reproductive hormonal abnormalities, sleep apnoea, depression, osteoarthritis and certain cancers. An algorithm has been developed (with PubMed and Medline searched for all relevant articles from 1 Jan 2000-1 Oct 2021) to (i) assist primary care physicians in treatment decisions for non-pregnant adults with obesity, and (ii) provide a practical clinical tool to guide the implementation of existing guidelines (summarised in Appendix 1) for the treatment of obesity in the Australian primary care setting. MAIN RECOMMENDATIONS AND CHANGES IN MANAGEMENT: Treatment pathways should be determined by a person's anthropometry (body mass index (BMI) and waist circumference (WC)) and the presence and severity of obesity-related complications. A target of 10-15% weight loss is recommended for people with BMI 30-40 kg/m2 or abdominal obesity (WC > 88 cm in females, WC > 102 cm in males) without complications. The treatment focus should be supervised lifestyle interventions that may include a reduced or low energy diet, very low energy diet (VLED) or pharmacotherapy. For people with BMI 30-40 kg/m2 or abdominal obesity and complications, or those with BMI > 40 kg/m2 a weight loss target of 10-15% body weight is recommended, and management should include intensive interventions such as VLED, pharmacotherapy or bariatric surgery, which may be required in combination. A weight loss target of > 15% is recommended for those with BMI > 40 kg/m2 and complications and they should be referred to specialist care. Their treatment should include a VLED with or without pharmacotherapy and bariatric surgery.
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Affiliation(s)
- Tania P Markovic
- Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | | | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - Georgia Rigas
- St George Private Hospital, Kogarah, NSW 2217, Australia.
| | - Gary Deed
- HealthCarePlus Medical Centre, Carindale, QLD 4152, Australia; Monash University, Clayton, VIC 3800, Australia.
| | - Jeffrey M Hamdorf
- Medical School, University of Western Australia, Crawley, WA 6009, Australia.
| | - Erica Bessell
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | - Nathalie Kizirian
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
| | | | - Stephen Colagiuri
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
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Medeiros VGD, Pajecki D, Dias MCG, Dantas ACB, Cleva RD, Santo MA. FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:370-374. [PMID: 36102434 DOI: 10.1590/s0004-2803.202203000-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. METHODS Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. RESULTS Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. CONCLUSION Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.
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Affiliation(s)
- Veronica Garcia de Medeiros
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Denis Pajecki
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Roberto de Cleva
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Selenium Deficiency After Bariatric Surgery, Incidence and Symptoms: a Systematic Review and Meta-Analysis. Obes Surg 2022; 32:1719-1725. [PMID: 35218005 DOI: 10.1007/s11695-022-05932-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
This study review the prevalence of selenium deficiency after bariatric surgery, incidence, and symptoms. A systematic literature search and meta-analysis was performed in PubMed and Scopus for articles published by November 1, 2021, including the keywords "Roux-en Y gastric bypass", "RYGB", "Omega bypass", "Mini bypass", "One anastomosis gastric bypass", "Bariatric surgery", "Weight loss surgery", "Metabolic surgery", "Gastric bypass", "Loop gastric bypass", "Selenium", "Selenium deficiency", or a combination of aimed tothem in the title or abstract. In this review, nine studies examining a total of 1174 patients were included in this meta-analysis. The mean age of the patients was 41.14 ± 7.69 years. The mean interval between bariatric surgery and selenium deficiency was 40.36 ± 43.29 months. Mean BMI before surgery and at the time of selenium deficiency was 43.68 ± 4.91 kg/m2 and 28.41 ± 9.09 kg/m2, respectively. Additionally, the results showed a prevalence of 16% and 2% of selenium deficiency at 1- and 2-year follow-up after bariatric surgery, respectively. Symptoms included weakness, myopathy, and cardiomyopathy, loss of muscle mass, erythematous desquamating eruption, lethargy, dyspnea, and bilateral lower extremity pitting edema. Forty percent of studies reported "Selenium orally (100 μg once daily)" as treatment option. A multidisciplinary team of healthcare professionals, including dietitians, should be involved in the bariatric patient's care. As a result, clinicians should encourage patients to take supplements for the rest of their lives, and patients should be monitored after surgery if necessary.
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22
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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.
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Erdem NZ, Mert-Biberoğlu F, Taşkın HE. The Relationship between Bariatric Food Pyramid and Long-Term Anthropometric Measurements of Patients Undergoing Bariatric Surgery. Int J Clin Pract 2022; 2022:8291512. [PMID: 35685542 PMCID: PMC9170505 DOI: 10.1155/2022/8291512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
The bariatric food pyramid is a standard for long-term healthy living and nutritional habits of patients who have undergone bariatric surgery, taking their gastric capacity and special nutritional requirements into account. This study aimed to evaluate how the compliance with the pyramid affects the anthropometric change in patients who have undergone bariatric surgery, depending on the period after surgery. 81 patients who have undergone bariatric surgery between August 2016 and September 2018 participated in the study. The patients were evaluated in the postoperative period and were divided into three groups according to the year they had the operation. Food consumption frequency information was obtained from the patients, and the amount of food consumed per day was recorded in grams. Protein, vegetable, fruit, grain, and oil consumption was calculated according to the pyramid and calculated as portions. A statistically significant difference was found for all three groups in terms of weight loss and body mass index (BMI) changes before and after surgery (p < 0.001, p < 0.001, respectively). It was observed that the amount of protein consumed by the patients was sufficient, cereal was high, and fruit was insufficient. Patients who consumed foods that were not recommended slowed in weight loss. In conclusion, it is estimated that increased consumption of grains and nonrecommended foods may cause weight gains. In order to prevent this, it is necessary to ensure that patients are fed in accordance with the pyramid and followed for many years.
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Affiliation(s)
- Nihal Zekiye Erdem
- Istanbul Medipol University, School of Health Sciences, Department of Nutrition and Dietetic, Istanbul, Turkey
| | - Fatma Mert-Biberoğlu
- Istanbul Medipol University, School of Health Sciences, Department of Nutrition and Dietetic, Istanbul, Turkey
| | - Halit Eren Taşkın
- Istanbul University-Cerrahpaşa, Department of Metabolic & Bariatric Surgery, Department of General Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey
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24
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Food Tolerance, Nutritional Status and Health-Related Quality of Life of Patients with Morbid Obesity After Bariatric Surgery. Clin Nutr ESPEN 2022; 48:321-328. [DOI: 10.1016/j.clnesp.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
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25
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Gamble LA, Davis JL. Surveillance and Surgical Considerations in Hereditary Diffuse Gastric Cancer. Gastrointest Endosc Clin N Am 2022; 32:163-175. [PMID: 34798984 DOI: 10.1016/j.giec.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Inactivating germline variants in the CDH1 tumor suppressor gene cause the hereditary diffuse gastric cancer syndrome. Total gastrectomy is recommended for prevention, although it is associated with adverse outcomes and chronic health risks. Gastric cancer surveillance is an alternative to surgery; however, upper gastrointestinal endoscopy is limited by poor sensitivity. Cancer surveillance requires accurate detection of early carcinoma and patient-specific disease penetrance estimates. Current clinical care should incorporate up-to-date information on variable disease penetrance, which does not seem to correlate with CDH1 genotype. Affected patients and families warrant a balanced presentation of options for cancer surveillance and prophylaxis.
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Affiliation(s)
- Lauren A Gamble
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room 4-3742, Bethesda, MD 20892, USA
| | - Jeremy L Davis
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room 4-3742, Bethesda, MD 20892, USA.
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26
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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Norouzian Ostad A, Barghchi H, Jangjoo A, Ranjbar G, Rezvani R, Bahrami LS, Goshayeshi L, Khadem-Rezaiyan M, Nematy M. Macro- and Micro-nutrient Intake Adequacy in Gastric Bypass Patients after 24 Months: a Cross-sectional Study. Clin Nutr Res 2021; 10:341-352. [PMID: 34796138 PMCID: PMC8575647 DOI: 10.7762/cnr.2021.10.4.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/19/2023] Open
Abstract
Decreased food intake is an effective mechanism for gastric bypass surgery (GBS) for successful weight loss. This cross-sectional study aimed to assess dietary intake, micro-and macro-nutrients in the patients undergoing GBS and determine the possible associations with weight changes. We assessed anthropometric indices and food intake at 24 month-post gastric bypass surgery. Dietary data was evaluated using three-day food records. After the 24 months of surgery, among 35 patients (mean age: 43.5 ± 11.2 years; 82.85% females), with the mean body mass index (BMI) of 30.5 ± 4.5 kg/m2, 17 cases were < 50% of their excess weight. The average daily calorie intake was 1,733 ± 630 kcal, with 14.88% of calories from protein. Consumption amounts of protein (0.82 ± 0.27 g/kg of the current weight), as well as fiber, and some micro-nutrients (vitamin B9, E, K, B5, and D3) were lower than recommended amounts. Patients were classified into three groups based on their success in weight loss after surgery. Calorie intake was not significantly different between groups, but successful groups consumed considerably more protein and less carbohydrate than the unsuccessful group (p < 0.05). Based on our findings, the patients undergoing GBS had inadequate macro- and micro-nutrient intake after 24 months. However, protein intake can affect patients' success in achieving better weight loss. Long-term cohort and clinical studies need to be conducted to comprehend this process further.
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Affiliation(s)
- Andisheh Norouzian Ostad
- Department of Nutritional Sciences, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Hanieh Barghchi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Golnaz Ranjbar
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Reza Rezvani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Leila Sadat Bahrami
- Department of Nutritional Sciences, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran.,Gastroenterology and Hepatology Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine and Public Health, Faculty of medicine, Mashhad university of Medical Sciences, Mashhad 91779-48564, Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
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28
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Is Inflammation Status in Postbariatric Patients Predictive for Their Response to Vitamin B12 Supplementation Therapy? Int Surg 2021. [DOI: 10.9738/intsurg-d-16-00263.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Several studies indicate that there is a relationship between vitamin B12 levels and inflammatory status. Some studies showed a significantly correlation between vitamin B12 status and inflammation. The aim of this study is to investigate the influence of inflammatory status on the effect of different vitamin B12 supplementation regimes.
Methods
We selected patients with a vitamin B12 deficiency based on methylmalonic acid (MMA) levels. A moderate vitamin B12 deficiency was defined as an MMA blood level between ≥300 and 430 nmol/L. In included patients, C-reactive protein (CRP), leukocytes, serum vitamin B12, and MMA levels were measured at baseline and after 6 months of follow-up.
Results
A total of 63 patients were included, treated with 3, 6, or no intramuscular vitamin B12 injections. In the 6 intramuscular injections group, the presupplementation CRP levels significantly predicted the response in terms of vitamin B12 increase (P = 0.015). Also, there was a significant reduction in CRP levels (P = 0.03) after 6 injections. There was a significant correlation between presupplementation MMA and presupplementation CRP (r = 0.127, P = 0.049).
Conclusion
This study showed that presupplementation CRP levels significantly predicted the response on 6 intramuscular vitamin B12 injections in patients after bariatric surgery. Second, the 6 intramuscular injection regimen showed a significant reduction in CRP levels. Third, there was a significant correlation between MMA and presupplementation CRP. This might indicate that there is interplay between the vitamin B12 supplementation and inflammatory levels in patients after bariatric surgery.
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Are There Ethnic Differences in Micronutrient Deficiencies in Preoperative Bariatric Patients? A Systematic Review and Meta-analysis. Obes Surg 2021; 31:5005-5021. [PMID: 34383257 DOI: 10.1007/s11695-021-05625-1] [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: 04/18/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this systematic review was to determine if in patients presenting for bariatric surgery, patients of different ethnicities, have different micronutrient deficiencies preoperatively. Databases searched were PubMed, Embase, MEDLINE and Cochrane Library. A meta-analysis of prevalence of vitamin D insufficiency (<20ng/ml) was carried out using a random effects model. Twenty-eight articles were included assessing preoperative micronutrient status across different ethnic groups. The most common micronutrient assessed was vitamin D, and the most assessed ethnicity was Caucasian. African Americans had the greatest prevalence of vitamin D insufficiency when compared to other ethnicities with a pooled prevalence and 95% confidence interval of 0.80 [0.74; 0.85]. There was a significant difference in vitamin D insufficiency when compared across ethnicities (p <0.01).
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30
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Kolen AM, Romeijn MM, Holthuijsen DDB, Janssen L, Greve JWM, Leclercq WKG, van Dielen FMH. Current preoperative strategies applied in the Dutch bariatric centers: A national survey. Clin Obes 2021; 11:e12461. [PMID: 34028197 PMCID: PMC8365720 DOI: 10.1111/cob.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
There is no consensus about the optimal management of patients undergoing bariatric surgery. This study aimed to identify current weight loss goals prior to bariatric surgery, as well as aimed to explore preoperative strategies related to diet, nutritional supplements and physical activity. An online survey was distributed among bariatric surgeons and dietitians in all 18 Dutch bariatric centers. This survey included the following four domains: weight loss, diet, nutritional supplements and physical activity. For the analyses one answer per center was used, either the most common answer or the answer given by the most expert responder. All 18 centers reported at least one response. Preoperative weight loss was requested in 28% of the centers, whereas 61% desired a stable weight or weight loss, and 11% had no requests. A preoperative diet was routinely recommended in 78% of the centers and on indication (ie, depending on baseline weight and/or comorbidity status) in 22%. The most frequently prescribed diet was a low-energy diet (800-1500 kcal/day) in 44% of the centers. Nutritional supplements were recommended in 78% of the centers. Physical activity with low intensity was recommended in 83% of the centers, while physical exercise training with mid- to high-intensity was recommended in 72%. Inconsistent responses within centers were observed in 56% of the questions. The current bariatric practice within the Netherlands shows high variability and inconsistencies in preoperative management. Consensus-building and standardization of strategies should be promoted in the future.
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Affiliation(s)
- Aniek M. Kolen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. Romeijn
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniëlle D. B. Holthuijsen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Loes Janssen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
| | - Jan Willem M. Greve
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of SurgeryZuyderland Medical CenterHeerlenThe Netherlands
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31
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Aljaaly EA. Perioperative nutrition care and dietetic practices in the scope of bariatric surgery in Saudi Arabia using adapted protocols for evaluation. SAGE Open Med 2021; 9:20503121211036136. [PMID: 34377474 PMCID: PMC8326630 DOI: 10.1177/20503121211036136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/11/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives: This study evaluates the availability of perioperative nutritional care protocols and the practices of bariatric registered dietitians in Saudi Arabia. The primary outcomes of the study were conducted using an adapted American survey “with permission.” Methods: A cross-sectional survey of a selected 32 dietitians providing bariatric services completed a self-administered online questionnaire from 12 hospitals in Jeddah, Saudi Arabia. Results: All surveyed dietitians were females, mainly Saudi nationals (93.9%, n = 30), and accredited by the Saudi Commission for Health Specialties (93.8%, n = 30). Only 37.5% (n = 6) of the dietitians were specialized in bariatric surgery. Perioperative common practices of dietitians included a conduct of screening for nutrition risk before (44%, n = 14) and after surgery (62.5%, n = 20) and applied a nutrition management protocol that is mainly based on the application of nutrition care process (62.5%, n = 20). Dietitians (81%, n = 26) reported the importance of having standardized protocols for nutritional management of patients undoing bariatric surgery, where 69% (n = 22) confirmed the availability of pre-operative written protocols in hospitals and 75% (n = 24) confirmed the existence of post-operative protocols. Pre-operative practices included using approaches for weight loss before surgery, for example, very low and low-calorie diet. Dietitians (25%, n = 8) see two to ten patients per month. The sleeve gastrectomy procedure is the most often performed surgery. Conclusion: This is the first study to evaluate the perioperative nutrition care protocols and practices related to bariatric surgery in Saudi Arabia. Perioperative bariatric protocols are available, but some dietitians are not aware of their availability and contents. Researchers emphasize the importance of creating national protocols by the Saudi Credentials Body to standardize practices within the field.
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Affiliation(s)
- Elham Abbas Aljaaly
- An Associate Professor & Consultant in Clinical Nutrition at the Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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32
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Smelt HJM, Heusschen L, Theel W, van Rutte PWJ, Nijboer T, Pouwels S, Smulders JF, Hazebroek EJ. Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: a Multicentre Survey Study from the Patient's Perspective. Obes Surg 2021; 31:4316-4326. [PMID: 34304380 PMCID: PMC8310459 DOI: 10.1007/s11695-021-05571-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022]
Abstract
Purpose Lifelong multivitamin supplementation is recommended to prevent nutritional deficiencies. Despite this advice, deficiencies are common which may be due to poor adherence to MVS intake. The aim of this study was to identify which factors affect patient adherence to Multivitamin Supplement (MVS) intake after bariatric surgery. Materials and Methods A 42-item questionnaire was sent to 15,424 patients from four Dutch bariatric center. In total, 4975 patients wanted to participate of which 361 patients were excluded. A total of 4614 patients were included, and MVS users (n=4274, 92.6%) were compared to non-users (n=340, 7.4%). Most patients underwent Roux-en-Y gastric bypass (64.3%) or sleeve gastrectomy (32.3%). Results Seven hundred and ten patients (15.4%) reported inconsistent MVS use and 340 patients (7.4%) did not use any MVS at all. For inconsistent MVS users, most reported reasons included forgetting daily intake (68.3%), gastro-intestinal side effects (25.6%) and unpleasant taste or smell (22.7%), whereas for non-users gastro-intestinal side effects (58.5%), high costs (13.5%) and the absence of vitamin deficiencies (20.9%) were most frequently reported. Overall, 28.5% were dissatisfied about instructions on MVS use, attention paid to MVS use during medical consultation and the extent to which personal preferences were taken into account. Conclusion The attitude of bariatric patients towards MVS use is predominantly negative. It is important to provide accurate information on different options for MVS intake and collect information about patient’s personal preferences when prescribing supplements. Improving adherence to MVS intake is challenging and requires implementation of a shared decision-making process, further optimization of MVS formulas and exploring options for reimbursement. Graphical abstract ![]()
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Affiliation(s)
- H J M Smelt
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands. .,Obesity Center, Catharina Hospital, Eindhoven, The Netherlands.
| | - L Heusschen
- Department of Surgery, Vitalys, part of Rijnstate Hospital, Arnhem, The Netherlands
| | - W Theel
- Obesity Center, Franciscus Gasthuis & Vlietland, Rotterdam and Schiedam, The Netherlands
| | - P W J van Rutte
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - T Nijboer
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S Pouwels
- Department of Intensive Care, Elizabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - J F Smulders
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.,Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - E J Hazebroek
- Department of Surgery, Vitalys, part of Rijnstate Hospital, Arnhem, The Netherlands.,Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40:4745-4761. [PMID: 34242915 DOI: 10.1016/j.clnu.2021.03.031] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Marco Braga
- University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Franco Carli
- Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada
| | | | - Martin Hübner
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Lausanne, Lausanne, Switzerland
| | - Stanislaw Klek
- General Surgical Oncology Clinic, National Cancer Institute, Krakow, Poland
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Dan Waitzberg
- University of Sao Paulo Medical School, Ganep, Human Nutrition, Sao Paulo, Brazil
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Pierre Singer
- Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva, Israel
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Calikoglu F, Soyluk Selcukbiricik O, Bayraktar S, Barbaros U. Vision Loss Due to Severe Vitamin A Deficiency After Biliopancreatic Diversion. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fulya Calikoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Ozlem Soyluk Selcukbiricik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Serife Bayraktar
- Department of Surgical Medical Sciences, Department of Eye Diseases, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Umut Barbaros
- Department of General Surgery, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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35
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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36
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Parretti HM, Subramanian A, Adderley NJ, Abbott S, Tahrani AA, Nirantharakumar K. Post-bariatric surgery nutritional follow-up in primary care: a population-based cohort study. Br J Gen Pract 2021; 71:e441-e449. [PMID: 33824163 PMCID: PMC8041293 DOI: 10.3399/bjgp20x714161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks. AIM To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, after patients are discharged from specialist bariatric care. DESIGN AND SETTING Retrospective cohort study in primary care practices contributing to IQVIA Medical Research Data in the UK (1 January 2000 to 17 January 2018). METHOD Participants were adults who had had bariatric surgery with a minimum of 3 years' follow-up post-surgery, as this study focused on patients discharged from specialist care (at 2 years post-surgery). Outcomes were the annual proportion of patients from 2 years post-surgery with a record of recommended nutritional screening blood tests, weight measurement, and prescription of nutritional supplements, and the proportions with nutritional deficiencies based on blood tests. RESULTS A total of 3137 participants were included in the study, and median follow-up post-surgery was 5.7 (4.2-7.6) years. Between 45% and 59% of these patients had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, for example, recorded haemoglobin measurement varied between 44.9% (n = 629/1400) and 61.2% (n = 653/1067). Annual proportions of blood tests specific to bariatric surgery were low, for example, recorded copper measurement varied between 1.2% (n = 10/818) and 1.5% (n = 16/1067) where recommended. Results indicated that the most common deficiency was anaemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low. CONCLUSION This study suggests that patients who have bariatric surgery are not receiving the recommended nutritional monitoring after discharge from specialist care. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand the reasons underpinning these findings.
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Affiliation(s)
- Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Sally Abbott
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham; Centre for Endocrinology Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham; CEDAM, Birmingham Health Partners, Birmingham; Department of Diabetes, Endocrinology and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham; Midlands Health Data Research UK
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37
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Jamil LC, Suzuki VY, Ferreira LM. Preoperative Nutritional Parameters for Postbariatric Patients: A Review of Key Recommendations. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liliane Carvalho Jamil
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Vanessa Yuri Suzuki
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Lydia Masako Ferreira
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
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Voglino C, Tirone A, Ciuoli C, Benenati N, Bufano A, Croce F, Gaggelli I, Vuolo ML, Badalucco S, Berardi G, Cuomo R, Castagna MG, Vuolo G. Controlling Nutritional Status (CONUT) Score and Micronutrient Deficiency in Bariatric Patients: Midterm Outcomes of Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass/Mini Gastric Bypass. Obes Surg 2021; 31:3715-3726. [PMID: 34031850 DOI: 10.1007/s11695-021-05486-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Two of the most common bariatric procedures performed worldwide are Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). Comparative data regarding nutritional status are lacking and no previous study focus on malnutrition according to a validated score. METHODS Retrospective data from a single institution were reviewed. Anthropometric variables and nutritional data were assessed. The primary aim was to analyze and compare the nutritional status before and 3 years after RYGB vs OAGB using the controlling nutritional status (CONUT) score. The incidence of micronutrient deficiency and the remission of comorbidities in each group were defined as secondary outcomes. RESULTS Fifty-seven patients in each arm were enrolled. A 3-year mild malnutrition (CONUT score 2-3) was found in 38% and 37.05% in the RYGB and OAGB groups, respectively (p > 0.05). In terms of percentage of total weight loss (%TWL) and percentage of adjustable weight loss (%AWL), no differences were found between OAGB and RYGB groups. OAGB and RYGB patients had similar vitamin deficiencies. Anemia, hypoproteinemia, hypoalbuminemia, and hypocalcemia were comparable between groups. At 3-year follow-up, total protein and albumin values were similar between arms while prealbumin deficit was more frequent after OAGB than after RYGB. The rate of type 2 diabetes (87.5% in OAGB and 92% in RYGB), arterial hypertension (51.6% in OAGB and 58.3% in RYGB), and dyslipidemia (69.7% in OAGB and 78.6% in RYGB) remission was not significantly different between the two groups. CONCLUSIONS Postoperative CONUT score, micronutrient deficiency, comorbidity remission, and improvement of anthropometric parameters 3 years postoperatively were comparable between RYGB and OAGB groups.
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Affiliation(s)
- Costantino Voglino
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy.
| | - Andrea Tirone
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Nicoletta Benenati
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Annalisa Bufano
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Federica Croce
- Department of Diagnostic Imaging - Hospital Campostaggia, Campostaggia, 53036, Poggibonsi, SI, Italy
| | - Ilaria Gaggelli
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Maria Laura Vuolo
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Simona Badalucco
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Giovanna Berardi
- Department of Advanced Biomedical Science, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neurosciences - Unit of Plastic Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Maria Grazia Castagna
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppe Vuolo
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
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Kindel TL, Ganga RR, Baker JW, Noria SF, Jones DB, Omotosho P, Volckmann ET, Williams NN, Telem DA, Petrick AT, Gould JC. American Society for Metabolic and Bariatric Surgery: Preoperative Care Pathway for Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2021; 17:1529-1540. [PMID: 34148848 DOI: 10.1016/j.soard.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Rama Rao Ganga
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - John Wilder Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Philip Omotosho
- Department of Surgery, Rush Medical College, Chicago, Illinois
| | - Erick T Volckmann
- Department of Surgery, University of Utah and Affiliated Hospitals, Salt Lake City, Utah
| | - Noel N Williams
- Department of Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon C Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Moon N, Figgins B, Altshuler E, Pham A, Kamel AY. Concurrent zinc and vitamin B 6 deficiencies in acutely exacerbated inflammatory bowel disease: Case reports. Nutr Clin Pract 2021; 37:203-208. [PMID: 33930197 DOI: 10.1002/ncp.10665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Limited evidence is available to describe the prevalence, causes, and consequences of zinc and vitamin B6 deficiencies in those with acutely exacerbated inflammatory bowel disease (IBD). Zinc is important for immune function and wound healing, and B6 is needed for metabolic and neurological function. Patients with IBD are at risk of micronutrient deficiencies, particularly during flares. PRESENTATIONS The cases of 2 patients with IBD exacerbations were reviewed in which deficiencies of both zinc and vitamin B6 were identified. CONCLUSIONS These cases highlight the need for increased screening for zinc and pyridoxine deficiencies in IBD population, especially during disease exacerbation. Therefore, we recommend a comprehensive nutrition workup with physical exam, diet history, and a complete micronutrient panel while ruling out contributing factors. If patients are susceptible to deficiencies during flares, prophylactic oral zinc and pyridoxine supplementation may be considered, with close monitoring for subsequent iron and copper deficiencies.
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Affiliation(s)
- Nabeel Moon
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Bradley Figgins
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellery Altshuler
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Angela Pham
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Amir Y Kamel
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pharmacotherapy and Transitional Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Andrade L, Chiote I, Santos-Cruz A, Brito-Costa A, Mendes L, Silva-Nunes J, Pereira J. Protein Intake, Adherence to Vitamin-Mineral Supplementation, and Dumping Syndrome in Patients Undergoing One Anastomosis Gastric Bypass. Obes Surg 2021; 31:3557-3564. [PMID: 33880746 DOI: 10.1007/s11695-021-05428-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) is an effective bariatric procedure. However, nutritional deficiencies or dumping syndrome (DS) may occur. The aim of this study was to assess adherence to nutritional recommendations and development of DS in a 3-year OAGB patient follow-up. METHODS For 150 OAGB patients, in our center, data were collected through the electronic platform and by an individual telephone interview. The inclusion criterion is OAGB as a primary bariatric procedure, no revisional surgery, or no pregnancy. The adequacy of daily protein intake cutoff was defined as 60 g. Adherence to micronutrient supplementation protocol was considered if a minimum of 5 takes/week were reported. To evaluate the occurrence of DS, the Sigstad score questionnaire was used. For statistical analysis, a significance level less than 5% (p < 0.05) was considered. RESULTS A total of 150 patients (80% females), BMI 44.3 ± 21.3 kg/m2, were subjected to the OAGB procedure. Of those, 128 fulfilled the study inclusion criteria. After 3 years, the mean %EBMIL was 78.4 ± 14.4. During the 3-year follow-up, the average protein intake was 60 g/day, and 48% reported an adequate daily protein intake. Adherence to the micronutrient supplementation protocol was reported by 70%. According to the Sigstad score questionnaire, DS was present in 24% of patients. CONCLUSION A significant part of OAGB patients does not comply with the nutrition prescription assessed, emphasizing the need to improve team/patient communication strategies. Long-term studies are needed to characterize and assess the health impact of protein, vitamin, and mineral malnutrition in patients undergoing OAGB.
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Affiliation(s)
- Léneo Andrade
- Department of Nutrition, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. .,Multidisciplinary Department of Bariatric and Metabolic Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Inês Chiote
- Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
| | - Ana Santos-Cruz
- Department of Nutrition, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Multidisciplinary Department of Bariatric and Metabolic Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Brito-Costa
- Department of Nutrition, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - Lino Mendes
- Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
| | - José Silva-Nunes
- Multidisciplinary Department of Bariatric and Metabolic Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal.,Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, New University of Lisbon, Lisbon, Portugal
| | - João Pereira
- Multidisciplinary Department of Bariatric and Metabolic Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Zarshenas N, Tapsell LC, Neale EP, Batterham M, Talbot ML. The Relationship Between Bariatric Surgery and Diet Quality: a Systematic Review. Obes Surg 2021; 30:1768-1792. [PMID: 31940138 DOI: 10.1007/s11695-020-04392-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bariatric surgery is currently the most effective treatment for morbid obesity. These procedures change the gastrointestinal system with the aim of reducing dietary intake. Improving diet quality is essential in maintaining nutritional health and achieving long-term benefits from the surgery. The aim of this systematic review was to examine the relationship between bariatric surgery and diet quality at least 1 year after surgery. METHODS A systematic search of five databases was conducted. Studies were included that reported diet quality, eating pattern, or quality of eating in adult patients who had undergone laparoscopic-adjusted gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) procedures. Data was extracted to determine the relationship between having had bariatric surgery and subsequent diet quality. RESULTS A total of 34 study articles (described in 36 articles) met the inclusion criteria. The majority of studies were observational in nature and showed a reduction in energy intake following surgery, as well as inadequate intakes of micronutrients and protein, and an excessive intake of fats. There was evidence of nutrient imbalances, suboptimal compliance with multivitamin and mineral supplementation, and limited follow-up of patients. CONCLUSION The current evidence base suggests that despite being effective in reducing energy intake, bariatric surgery can result in unbalanced diets, inadequate micronutrient and protein intakes, and excessive intakes of fats. In combination with suboptimal adherence to multivitamin and mineral supplementation, this may contribute to nutritional deficiencies and weight regain. There is a need for high-quality nutrition studies, to identify optimal dietary compositions following bariatric surgery.
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Affiliation(s)
- Nazy Zarshenas
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Shore Surgical, 156-158 Pacific Highway, Greenwich, NSW, 2065, Australia.
| | - Linda Clare Tapsell
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth Phillipa Neale
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Michael Leonard Talbot
- Upper Gastrointestinal Surgery, St George Private Hospital, Kogarah, Sydney, NSW, Australia
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43
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Ivezaj V, Carr MM, Brode C, Devlin M, Heinberg LJ, Kalarchian MA, Sysko R, Williams-Kerver G, Mitchell JE. Disordered eating following bariatric surgery: a review of measurement and conceptual considerations. Surg Obes Relat Dis 2021; 17:1510-1520. [PMID: 34083136 DOI: 10.1016/j.soard.2021.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 02/24/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.
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Affiliation(s)
| | - Meagan M Carr
- Yale University School of Medicine, New Haven, Connecticut
| | - Cassie Brode
- West Virginia University School of Medicine, West Virginia
| | - Michael Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | | | - Robyn Sysko
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Şen O, Türkçapar AG. Hair Loss After Sleeve Gastrectomy and Effect of Biotin Supplements. J Laparoendosc Adv Surg Tech A 2021; 31:296-300. [DOI: 10.1089/lap.2020.0468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ozan Şen
- Obesity Center, Türkçapar Bariatrics, İstanbul, Turkey
- Department of Health Sciences, Nişantaşı University, İstanbul, Turkey
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Abstract
PURPOSE OF REVIEW Bariatric surgery is an effective treatment option for severe and complex obesity; however, those who undergo such surgery need access to nutritional monitoring and vitamin and mineral supplementation to avoid the development of nutritional deficiencies. RECENT FINDINGS The British Obesity and Metabolic Surgery Society and the American Society for Metabolic and Bariatric Surgery have recently updated their recommendations on preoperative and postoperative nutritional monitoring and supplementation. There is a growing interest in the more malabsorptive procedures that are associated with an increased risk of nutritional deficiencies. Nutritional monitoring and prevention of nutritional deficiencies are discussed.Long-term follow-up that includes annual nutritional monitoring and access to a dietetic annual review is recommended; however, in the United Kingdom, many bariatric surgery centres are only commissioned to provide 2 years of follow-up, after which care is transferred to the general practitioner. Consideration should be given to developing shared care models for aftercare and also for the aftercare of malabsorptive procedures to remain with specialist centres. SUMMARY Bariatric surgery is a safe and effective treatment option for severe and complex obesity. It is essential that patients have access to lifelong nutritional monitoring adjustment of vitamin and mineral supplements to prevent nutritional issues.
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Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Changes in Anthropometric Measures, Nutritional Indices and Gastrointestinal Symptoms Following One Anastomosis Gastric Bypass (OAGB) Compared with Roux-en-y Gastric Bypass (RYGB). Obes Surg 2021; 31:2619-2631. [PMID: 33624210 PMCID: PMC7901677 DOI: 10.1007/s11695-021-05284-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose Bariatric surgery is an effective treatment for obesity with new procedures emerging. However, despite comparable weight loss and improvements in metabolic outcomes, research on nutritional and gastrointestinal symptoms remains limited. Here we compare clinical data on weight, nutritional disorders and gastrointestinal symptoms of patients before and following one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric Bypass (RYGB). Materials and Methods In this retrospective study, data on anthropometry, nutritional indices, dietary intake and gastrointestinal symptoms were retrieved in cohorts of patients up to 2 years following OAGB and RYGB. Results Seventy-three patients had either a RYGB (28) or an OAGB (45), with 71% seeking these as a revisional procedure. Significant and higher weight loss was observed in the OAGB cohort at 1 year (%TWL 33.0 ± 8.5 vs. 26.6 ± 12.4), albeit comparable at 2 years postoperatively (%TWL 29.0 ± 11.1 vs. 34.1 ± 11.2). Disorders such as vitamin D, active B12, folate, homocystein (Hcy) and hyperparathyroidism were present following both surgeries. Levels of vitamin D, ferritin and total protein significantly worsened over time. Gastrointestinal symptoms of diarrhoea, steatorrhoea and reflux were higher in the OAGB cohort while the RYGB cohort reported more dumping syndrome (DS). Conclusion Significant and similar weight loss results are seen following both OAGB and RYGB. Nutritional disorders were common in both cohorts and increased over time. However, the OAGB patients reported more gastrointestinal side effects, which may contribute to poor quality of life and nutritional consequences. Prospective and longer-term studies investigating the nutritional and gastrointestinal health of patients undergoing OAGB is recommended.
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Affiliation(s)
- Nazy Zarshenas
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
- Shore Surgical, Suite 204, Level 2/156 Pacific Highway, Greenwich, NSW 2065 Australia
| | - Linda Clare Tapsell
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW Australia
| | - Elizabeth Phillipa Neale
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Michael Leonard Talbot
- Upper Gastrointestinal Surgery, St George Private Hospital, Kogarah, Sydney, NSW 2217 Australia
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Wise ES, Beckman TR, Amateau SK, Ikramuddin S, Leslie DB. The Role of Preoperative Anemia in Predicting Short-Term Morbidity and Mortality After Roux-en-Y Gastric Bypass. Am Surg 2021; 87:1926-1933. [PMID: 33502216 DOI: 10.1177/0003134820982852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preoperative anemia has been suggested as a contraindication to gastric bypass. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement database, this study sought to determine the role of preoperative hematocrit on 30-day morbidity and mortality after laparoscopic Roux-en-Y gastric bypass for weight loss. METHODS A cohort of 31 981 patients was reviewed for factors associated with a composite primary end point including 30-day reoperation, readmission, reintervention, or mortality, including degree of anemia. Analyzed separately by gender, factors significant on bivariate analysis were included in nominal logistic multivariate analysis to assess for independent significance of the hematocrit level as a risk factor for the primary end point. RESULTS Upon multivariate analysis, the hematocrit level was significantly associated with the 30-day end point in the male cohort (P = .05), specifically, severe anemia (hematocrit <35%) conferred an increased risk relative to a normal hematocrit (odds ratio 1.5, P = .03). There was no association of hematocrit with the 30-day end point in the female cohort. CONCLUSION Bariatricians should carefully consider the appropriateness of a gastric bypass over a less anemogenic procedure such as sleeve gastrectomy in patients, particularly men with preoperative anemia.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Tiffany R Beckman
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stuart K Amateau
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Daniel B Leslie
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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Cambi MPC, Baretta GAP, Magro DDO, Boguszewski CL, Ribeiro IB, Jirapinyo P, de Moura DTH. Multidisciplinary Approach for Weight Regain-how to Manage this Challenging Condition: an Expert Review. Obes Surg 2021; 31:1290-1303. [PMID: 33392999 DOI: 10.1007/s11695-020-05164-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Weight regain is a multifactorial condition that affects many patients following bariatric surgery. The purpose of the paper is to review the multidisciplinary approach for the management of weight regain. We performed a search in current clinical evidence regarding the causes, consequences, and treatments of weight regain. The multidisciplinary approach with periodic monitoring is of fundamental importance to prevent or treat weight regain. Several therapeutic options are ranging from nutritional to surgical options, which should be tailored according to patients' anatomy, lifestyle behavior, and compliance. Specialized multidisciplinary care is the key to achieve optimal long-term weight loss and maintenance goals following bariatric surgery.
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Affiliation(s)
| | | | - Daniéla De Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas UNICAMP-SP, Campinas Sao Paulo, Brazil
| | | | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, Av. Dr Eneas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, Sao Paulo, 05403-010, Brazil.
| | - Pichamol Jirapinyo
- Division of Gasteoenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, Av. Dr Eneas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, Sao Paulo, 05403-010, Brazil.,Division of Gasteoenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Istfan NW, Lipartia M, Anderson WA, Hess DT, Apovian CM. Approach to the Patient: Management of the Post-Bariatric Surgery Patient With Weight Regain. J Clin Endocrinol Metab 2021; 106:251-263. [PMID: 33119080 PMCID: PMC7765654 DOI: 10.1210/clinem/dgaa702] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because there are no current guidelines for timely diagnosis and assessment of the severity of this condition. OBJECTIVE We present a practical approach for the early recognition of WR, based on 11-year follow-up data from our multiethnic bariatric surgery patient population. METHODS We classify WR according to the rate of increase in weight relative to nadir weight, normalized per 30-day interval. We also review pertinent literature about the etiologic factors contributing to WR after bariatric surgery. RESULTS According to our algorithm, mild, moderate, and rapid WR are defined as weight increases of 0.2% to <0.5%, 0.5% to 1.0%, and more than 1.0% of nadir weight per 30 days, respectively. Treatment options, including dietary counseling, use of antiobesity medication, and consideration of surgical revision, are described. A case is presented to illustrate the utility of timely identification of WR and the importance of collaboration between bariatric surgeons, obesity medicine specialists, and dietitians. CONCLUSION Our approach emphasizes the importance of regular long-term follow-up for all bariatric surgery patients.
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Affiliation(s)
- Nawfal W Istfan
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Marine Lipartia
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Wendy A Anderson
- Section of Minimally Invasive Surgery, Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Donald T Hess
- Section of Minimally Invasive Surgery, Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Caroline M Apovian
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
- Correspondence and Reprint Requests: Caroline M. Apovian, MD, Boston Medical Center, 720 Harrison Ave, Ste 8100, Boston, MA 02118, USA. E-mail:
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Rex SM, Russel K, Reiter-Purtill J, Zeller MH, Courcoulas A, West-Smith L, Robson SM. A cross-sectional examination of the home food environments of mothers who have undergone metabolic and bariatric surgery: a pilot study. Surg Obes Relat Dis 2020; 16:2016-2021. [DOI: 10.1016/j.soard.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023]
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