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de Waal D, Onuigbo M, Golper TA. Case Study: The Weighty Issue of Treatment Options for Obese Dialysis Patients. J Ren Nutr 2024:S1051-2276(24)00065-7. [PMID: 38685393 DOI: 10.1053/j.jrn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Obesity is a complex chronic disease and common comorbidity in kidney failure and is the leading causes of death and disability in this population. Guidelines do not specifically address the preferred weight management option(s) for obesity while on dialysis. Large body size is a limiting factor for consideration of a kidney transplantation. We report on a successful bariatric surgery with a young adult after 5.5 years on dialysis with hope for a future transplant. Success was demonstrated with progressive weight loss without adverse changes in renal clinical markers accompanied by improvements in exercise tolerance and health status thereby improving her suitability for a kidney transplant. Further studies and guidelines are needed to address weight loss options for those with obesity on dialysis and want to lose weight.
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Affiliation(s)
- Desiree de Waal
- Nephrology Services, University of Vermont Medical Center, Nephrology, Burlington, VT.
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
| | - Thomas Alan Golper
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
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Komorniak N, Kaczmarczyk M, Łoniewski I, Martynova-Van Kley A, Nalian A, Wroński M, Kaseja K, Kowalewski B, Folwarski M, Stachowska E. Analysis of the Efficacy of Diet and Short-Term Probiotic Intervention on Depressive Symptoms in Patients after Bariatric Surgery: A Randomized Double-Blind Placebo Controlled Pilot Study. Nutrients 2023; 15:4905. [PMID: 38068763 PMCID: PMC10707788 DOI: 10.3390/nu15234905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
(1) Background: studies have shown that some patients experience mental deterioration after bariatric surgery. (2) Methods: We examined whether the use of probiotics and improved eating habits can improve the mental health of people who suffered from mood disorders after bariatric surgery. We also analyzed patients' mental states, eating habits and microbiota. (3) Results: Depressive symptoms were observed in 45% of 200 bariatric patients. After 5 weeks, we noted an improvement in patients' mental functioning (reduction in BDI and HRSD), but it was not related to the probiotic used. The consumption of vegetables and whole grain cereals increased (DQI-I adequacy), the consumption of simple sugars and SFA decreased (moderation DQI-I), and the consumption of monounsaturated fatty acids increased it. In the feces of patients after RYGB, there was a significantly higher abundance of two members of the Muribaculaceae family, namely Veillonella and Roseburia, while those after SG had more Christensenellaceae R-7 group, Subdoligranulum, Oscillibacter, and UCG-005. (4) Conclusions: the noted differences in the composition of the gut microbiota (RYGB vs. SG) may be one of the determinants of the proper functioning of the gut-brain microbiota axis, although there is currently a need for further research into this topic using a larger group of patients and different probiotic doses.
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Affiliation(s)
- Natalia Komorniak
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Mariusz Kaczmarczyk
- Sanprobi sp. z o.o. sp. k., Kurza Stopka 5/C, 70-535 Szczecin, Poland; (M.K.); (I.Ł.)
| | - Igor Łoniewski
- Sanprobi sp. z o.o. sp. k., Kurza Stopka 5/C, 70-535 Szczecin, Poland; (M.K.); (I.Ł.)
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | | | - Armen Nalian
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX 75962, USA; (A.M.-V.K.); (A.N.)
| | - Michał Wroński
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Krzysztof Kaseja
- Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Bartosz Kowalewski
- Independent Provincial Public Hospital Complex in Szczecin-Zdunowo, 70-891 Szczecin, Poland;
| | - Marcin Folwarski
- Division of Clinical Nutrition and Dietetics, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
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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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Alvarez TS, Von Atzingen MCBC, Sarni ROS. Sensory analysis of formulations containing whey protein to individuals undergoing bariatric and metabolic surgery. BMC Surg 2023; 23:123. [PMID: 37173643 PMCID: PMC10176954 DOI: 10.1186/s12893-023-02004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Individuals undergoing bariatric surgery often have inadequate protein intake, which can cause loss of lean body mass, low level of physical activity and sarcopenia. The whey protein supplement is the most suitable in this situation, however there is a low adherence to long-term use due to the palatability and monotony of the recipes. The aim this study was to analyze the acceptability of recipes containing whey-based protein supplements in individuals undergoing bariatric and metabolic surgery. METHODS An on-demand sampling was performed, through a prospective, experimental study, with individuals undergoing bariatric surgery, treated by a multidisciplinary team, in a clinic located in São Paulo, Brazil. The study excluded: individuals with possible changes in taste during the sensory testing period. The study was divided into selection of recipes containing whey proteins, recruitment of tasters, sensory and chemical analysis of the recipes. RESULTS The sample consisted of 40 tasters, adults, and elderly, who underwent bariatric and metabolic surgery, with a median of eight years of surgery, who had previously consumed a supplement. These individuals were subjected to sensory analysis of six recipes with fresh and minimally processed foods, plus protein supplement. All recipes had food acceptance above 78% and the chemical analysis of the recipes showed an average of 13 g of protein per serving. CONCLUSION There was favorable acceptance of recipes with whey proteins, which places them as good dietary alternatives for the prevention of sarcopenia and weight relapse in individuals undergoing bariatric and metabolic surgery.
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Affiliation(s)
- Tatiana Souza Alvarez
- Nutrition Department of the Centro Universitário FMABC, Av. Lauro Gomes, 2000 - Sacadura Cabral, Santo André, São Paulo, CEP 09060-870, Brazil.
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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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Knopp KB, Sloan Stakleff K, Thomas TM, Mangira C, Chlysta WJ. Gender Influence on Weight and Body Composition Following Sleeve Gastrectomy: Outcomes Suggest Potential Bariatric Surgery Body Composition Goals. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Kim B. Knopp
- Bariatric Center retired, Cleveland Clinic Akron General, Akron, Ohio, USA
| | | | - Tonya M. Thomas
- Western Reserve Hospital Bariatric Center, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Caroline Mangira
- Department of Research, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Walter J. Chlysta
- Western Reserve Hospital Bariatric Center, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Freitas J, Bliven P, Case R. Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass. BMJ Case Rep 2019; 12:12/8/e230605. [PMID: 31377720 DOI: 10.1136/bcr-2019-230605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) surgery and alcohol use presented with a confluent erythematous rash involving the perineum spreading outward to the abdomen, thighs and lower back. She had angular cheilitis and glossitis. The rash was painful and blistering in scattered areas. She was hypotensive and appeared to be in septic or hypovolemic shock at presentation. Serum levels of zinc and vitamin B6 were critically low and biopsy of her rash returned suggestive of a nutritional deficiency as its source. The rash slowly improved over the following 2 weeks with oral zinc and vitamin B6 replacement. The body rash resembled that of infants born with inherited defects in zinc transporters, referred to as acrodermatitis enteropathica (AE). This case may represent an acquired case of AE in the setting of prior RYGB.
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Affiliation(s)
- Jared Freitas
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick Bliven
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Case
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
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