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Luijpers CLH, Nuijten MAH, Groenhuijzen EJ, van Hogezand LL, Monpellier VM, Eijsvogels TMH, Hopman MTE. Protein Supplement Tolerability and Patient Satisfaction after Bariatric Surgery. Obes Surg 2024:10.1007/s11695-024-07462-4. [PMID: 39243332 DOI: 10.1007/s11695-024-07462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Disproportional fat-free mass loss often occurs post-bariatric surgery, partly due to insufficient protein intake during the post-surgery recovery phase. We compared five protein-enhancing strategies (PES) on patient tolerability, satisfaction and protein intake. MATERIALS AND METHODS Ninety-four participants, scheduled for bariatric surgery, were enrolled and allocated to either of the following: (1) whey powder, (2) hydrolysed collagen powder, (3) plant-based powder, (4) protein-rich products, (5) protein gel, or control. PES groups were instructed to add 30 g of powder or 2 gels or protein products to their diet. Patient satisfaction and tolerability were evaluated with questionnaires. Dietary intake was assessed prior to and during PES use. RESULTS Seven patients dropped out (i.e. loss of contact, personal reasons or post-surgery complications) yielding an analytical cohort of 87 participants. The majority of patients (61%) did not experience dietary complaints from PES and could use PES ≥ 5 days of the week. PES non-usage was mainly related to taste dislike (58%). Hydrolysed collagen scored highest on tolerability and satisfaction: 86% of the participants could use HC ≥ 5 days and 71% were satisfied with the product. PES increased protein intake from 54.7 ± 21.5 g/day to 64.7 ± 23.4 g/day during the intervention (p = 0.002), which differed from the control group (+ 10.1 ± 24.5 g/day vs. - 6.3 ± 23.8 g/day for controls, p = 0.019). Whey showed the highest increase, namely + 18.3 ± 16.3 g/day (p = 0.009). CONCLUSION PES were tolerated by the majority of participants, and an improved protein intake with PES use was seen. However, the taste of the products could be improved to further enhance satisfaction and tolerability.
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Affiliation(s)
- Cornelia Lianda H Luijpers
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. box 1901, 6500 HB, Nijmegen, The Netherlands
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712 BA, Huis Ter Heide, The Netherlands
| | - Malou A H Nuijten
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. box 1901, 6500 HB, Nijmegen, The Netherlands
| | - Evi J Groenhuijzen
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. box 1901, 6500 HB, Nijmegen, The Netherlands
| | - Lilian L van Hogezand
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712 BA, Huis Ter Heide, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. box 1901, 6500 HB, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Medical BioSciences (Route 928), Radboud University Medical Center, P.O. box 1901, 6500 HB, Nijmegen, The Netherlands.
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Fulgoni VL, Agler A, Ricciuto L, DiFrancesco L, Williams D, Hertzler SR. Impact of Simulated Caloric Reduction on Nutrient Adequacy Among U.S. Adults with Overweight or Obesity (National Health and Nutrition Examination Survey [NHANES] 2015-2018). J Nutr 2024; 154:2732-2742. [PMID: 39025331 DOI: 10.1016/j.tjnut.2024.07.022] [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: 04/24/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Current guidelines for the treatment of obesity recommend dietary restriction to create a caloric deficit, and caloric reductions of 16% to 68% have been achieved in adults with overweight or obesity engaging in intentional weight loss programs. OBJECTIVES This study models the impact of simulated caloric reduction on nutrient adequacy among U.S. adults ≥19 y with overweight or obesity using National Health and Nutrition Examination Survey data (2015-2018). METHODS Four levels of caloric reduction (20%, 30%, 40%, and 50%) were modeled by prorating daily calorie intake such that usual intakes of 14 nutrients were reduced proportional to caloric reduction. The percentages below the estimated average requirement (EAR) or above the adequate intake (AI) were estimated at each level of caloric reduction, with and without dietary supplement use. Differences across percentages of simulated caloric reductions were determined using nonoverlapping confidence intervals of the means (97.5th percentile confidence intervals were used to approximate P < 0.05). RESULTS There were significant differences (P < 0.05) in percentages below the EAR (above the AI) between sequential levels of simulated caloric reduction for most of the nutrients analyzed (protein, vitamins A, B-6, folate, and C, calcium, iron, magnesium, potassium, and zinc). For example, after a simulated 30% caloric reduction, 25%-40% of the population had intakes below the EAR for protein, vitamin B-6, and zinc, and 75%-91% of the population had intakes below the EAR for vitamin A, calcium, and magnesium (vs. 4%-18% and 45%-56%, respectively, without caloric reduction). With the inclusion of dietary supplements, percentages below the EAR for all nutrients (except protein) were lower than those for food alone. CONCLUSIONS Caloric reduction may exacerbate nutrient inadequacies among adults with overweight or obesity. Inclusion of nutrient-dense foods, fortified foods, specially formulated products, and/or dietary supplements should be considered for those on calorie-restricted diets for long-term weight loss.
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Affiliation(s)
| | - Anne Agler
- Abbott Nutrition, Columbus, OH, United States
| | - Laurie Ricciuto
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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3
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Qanaq D, O'Keeffe M, Cremona S, Bernardo WM, McIntyre RD, Papada E, Benkalkar S, Rubino F. The Role of Dietary Intake in the Weight Loss Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:3021-3037. [PMID: 38907132 PMCID: PMC11289176 DOI: 10.1007/s11695-024-07183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 06/23/2024]
Abstract
The relationship between postoperative dietary intake and weight loss after bariatric surgery remains unclear. We performed a systematic review and meta-analysis of studies published between January 2000 and May 2023, reporting weight loss outcomes, and dietary intake before and after Roux-en-Y gastric bypass and sleeve gastrectomy. A total of 42 studies were included. There was no detectable difference in dietary intake between the two procedures. Roux-en-Y gastric bypass induced an average decrease in energy intake of 886 kcal/day at 12-month post-surgery; however, there was no correlation between daily energy intake and weight loss. These findings show a substantial reduction of energy intake in the first year after bariatric surgery but do not support a link between lower energy intake and greater weight loss.
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Affiliation(s)
- Dalal Qanaq
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, 11481, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, 11481, Riyadh, Kingdom of Saudi Arabia
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
- School of Food and Nutritional Sciences, University College Cork, College Road, Cork, Ireland
| | - Simone Cremona
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- General and Digestive Surgery Department of Hospital Del Mar de, 08003, Barcelona, Spain
| | | | - Robert D McIntyre
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- School of Sport, Exercise and Applied Science, St Mary's University, Twickenham, London, TW1 4SX, UK
| | - Efstathia Papada
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- Division of Medicine, University College London, London, WC1E 6JF, UK
| | - Saumit Benkalkar
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK.
- Bariatric and Metabolic Surgery, King's College Hospital, London, SE5 9RS, UK.
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Saiyalam C, Shantavasinkul PC, Chirnaksorn S, Rattanakaemakorn P, Taonam N, Rodphech V, Putadechakum S, Rattanasiri S, Sirivarasai J, Ongphiphadhanakul B, Sumritpradit P. Effects of Very Low-Calorie Diet versus Roux-en-Y Gastric Bypass Surgery on Body Composition in Patients with Obesity. Nutrients 2024; 16:2407. [PMID: 39125287 PMCID: PMC11313779 DOI: 10.3390/nu16152407] [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: 05/08/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is the most effective treatment for severe obesity. A very low-calorie diet (VLCD) is another effective dietary intervention to treat obesity. This study evaluated the effect of a VLCD versus RYGB on weight reduction, changes in body composition and the resolution of comorbidities during a 12-week period. Individuals with obesity at the obesity clinic, Ramathibodi Hospital, Mahidol University, Thailand with a body mass index (BMI) ≥ 37.5 kg/m2 or ≥32.5 kg/m2 with obesity-related complications were recruited. Treatment options, either RYGB or VLCD, were assigned depending on patients' preferences and physicians' judgment. The analysis included 16 participants in the RYGB group and 15 participants in the VLCD group. Baseline characteristics were similar between groups; nevertheless, the participants in the VLCD group were significantly younger than those in the RYGB group. The number of patients with type 2 diabetes (T2D) was slightly higher in the RYGB group (43.8% vs. 33.3%, p = 0.552). Additionally, patients in the RYGB group had a longer duration of T2D and were treated with anti-diabetic agents, while VLCD patients received only lifestyle modifications. At 12 weeks, total and percentage weight loss in the RYGB and VLCD groups, respectively, were as follows: -17.6 ± 6.0 kg vs. -15.6 ± 5.1 kg (p = 0.335) and -16.2% ± 4.3% vs. -14.1% ± 3.6% (p = 0.147). Changes in biochemical data and the resolution of comorbidities were similar between the groups at 12 weeks. A 12-week VLCD resulted in similar weight loss and metabolic improvement compared with RYGB. Large-scale studies with long follow-up periods are needed to elucidate whether VLCD is a viable alternative treatment to bariatric surgery.
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Affiliation(s)
- Chanawit Saiyalam
- Doctor of Philosophy Program in Nutrition, Faculty of Medicine Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Bangkok 10400, Thailand;
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Supphamat Chirnaksorn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Ploysyne Rattanakaemakorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Naphat Taonam
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Vorachat Rodphech
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Supanee Putadechakum
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Jintana Sirivarasai
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Boonsong Ongphiphadhanakul
- Division of Endocrine and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Preeda Sumritpradit
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
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5
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Lobão SL, Oliveira AS, Bressan J, Pinto SL. Contribution of Ultra-Processed Foods to Weight Gain Recurrence 5 Years After Metabolic and Bariatric Surgery. Obes Surg 2024; 34:2492-2498. [PMID: 38762612 DOI: 10.1007/s11695-024-07291-5] [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: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The aim of this study was to evaluate evolution of ultra-processed food intake and recurrent weight gain in patients who underwent Roux-en-Y gastric bypass. MATERIALS AND METHODS This study is an observational longitudinal study that evaluated patients who underwent metabolic and bariatric surgery at four time points: before surgery and at 3, 12, and 60 months after surgery. Anthropometric and dietary intake data were collected through two 24-h dietary recalls. All foods consumed were classified according to degree of processing. Recurrent weight gain was considered the difference between current weight and nadir weight. RESULTS The sample consisted of 58 patients with a mean age of 38.7 ± 8.9 years and 68% female. After 60 months, mean excess weight loss and recurrent weight gain were 73.6 ± 27.2% and 22.5 ± 17.4%. Calorie and macronutrient intake decreased significantly between the pre-surgery period, and 3 and 12 months post-surgery; however, there was no significant difference after 60 months. In relation to food groups or macronutrients, no difference was observed between the pre-surgery period and 60 months post-surgery. The contribution of unprocessed or minimally processed foods to calorie intake gradually decreased after 3 months post-surgery. CONCLUSION The profile of dietary intake after 60 months of metabolic and bariatric surgery tends to approach that of the pre-surgery period. The contribution of unprocessed and minimally processed foods to calorie intake decreased after 60 months, while ultra-processed food contribution increased.
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Affiliation(s)
- Stephany L Lobão
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil
| | - Adler S Oliveira
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, MG, Brazil
| | - Sônia L Pinto
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil.
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Schiavo L, Santella B, Paolini B, Rahimi F, Giglio E, Martinelli B, Boschetti S, Bertolani L, Gennai K, Arolfo S, Bertani MP, Pilone V. Adding Branched-Chain Amino Acids and Vitamin D to Whey Protein Is More Effective than Protein Alone in Preserving Fat Free Mass and Muscle Strength in the First Month after Sleeve Gastrectomy. Nutrients 2024; 16:1448. [PMID: 38794686 PMCID: PMC11123955 DOI: 10.3390/nu16101448] [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: 04/15/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES Sleeve gastrectomy (SG) is one of the most commonly performed weight loss (WL) bariatric procedures. The main goal of WL is reducing total body weight (TBW) and fat mass (FM). However, TBW loss is systematically accompanied by a decline in fat-free mass (FFM), predominantly in the first post-surgical month, despite protein supplementation. Branched-chain amino acids (BCAAs) and vitamin D seem to attenuate loss of FFM and, thus, reduce the decline in muscle strength (MS). However, data on the role of an integrated supplementation with whey protein plus BCAAs plus vitamin D (P+BCAAs+Vit.D) vs. protein alone on total weight loss (TWL), fat mass (FM), fat-free mass (FFM), and (MS) in the first month after SG are lacking. Therefore, the present study aims to evaluate the impact of P+BCAAs+Vit.D vs. protein alone supplementation on TWL, FM, FFM, and MS in the first month after SG. MATERIALS AND METHODS Before SG and at 1 month afterward, we prospectively measured and compared TBW, FM, FFM, and MS in 57 patients who received either a supplementation with P+BCAAs+Vit.D (n = 31) or protein alone (n = 26). The impact of P+BCAAs+Vit.D and protein alone supplementation on clinical status was also evaluated. RESULTS Despite non-significant variation in TBW, FM decreased more significantly (18.5% vs. 13.2%, p = 0.023) with the P+BCAA+Vit.D supplementation compared to protein alone. Furthermore, the P+BCAA+Vit.D group showed a significantly lower decrease in FFM (4.1% vs. 11.4%, p < 0.001) and MS (3.8% vs. 18.5%, p < 0.001) compared to the protein alone group. No significant alterations in clinical status were seen in either group. CONCLUSION P+BCAA+Vit.D supplementation is more effective than protein alone in determining FM loss and is associated with a lower decrease in FFM and MS, without interfering with clinical status in patients 1 month after SG.
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Affiliation(s)
- Luigi Schiavo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
- NBFC—National Biodiversity Future Center, 90133 Palermo, Italy
| | - Biagio Santella
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
- NBFC—National Biodiversity Future Center, 90133 Palermo, Italy
| | - Barbara Paolini
- Department of Innovation, Experimentation and Clinical Research, Unit of Dietetics and Clinical Nutrition, Santa Maria Alle Scotte Hospital, University of Siena, 53100 Siena, Italy; (B.P.); (B.M.); (K.G.)
| | - Farnaz Rahimi
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.R.); (S.B.)
| | - Emmanuele Giglio
- Department of Bariatric Surgery, Clinical Institute “Beato Matteo”, 27029 Vigevano, Italy; (E.G.); (L.B.); (M.P.B.)
| | - Barbara Martinelli
- Department of Innovation, Experimentation and Clinical Research, Unit of Dietetics and Clinical Nutrition, Santa Maria Alle Scotte Hospital, University of Siena, 53100 Siena, Italy; (B.P.); (B.M.); (K.G.)
| | - Stefano Boschetti
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.R.); (S.B.)
| | - Lilia Bertolani
- Department of Bariatric Surgery, Clinical Institute “Beato Matteo”, 27029 Vigevano, Italy; (E.G.); (L.B.); (M.P.B.)
| | - Katia Gennai
- Department of Innovation, Experimentation and Clinical Research, Unit of Dietetics and Clinical Nutrition, Santa Maria Alle Scotte Hospital, University of Siena, 53100 Siena, Italy; (B.P.); (B.M.); (K.G.)
| | - Simone Arolfo
- General Surgery, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Maria Paola Bertani
- Department of Bariatric Surgery, Clinical Institute “Beato Matteo”, 27029 Vigevano, Italy; (E.G.); (L.B.); (M.P.B.)
| | - Vincenzo Pilone
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
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Li S, Zhang P, Di J, Han X, Tu Y, Yang D, Xu R, Xiao Y, Zhou J, Bao Y, Yin J, Yu H, Jia W, Han J. Associations of change in body fat percentage with baseline body composition and diabetes remission after bariatric surgery. Obesity (Silver Spring) 2024; 32:871-887. [PMID: 38515375 DOI: 10.1002/oby.24003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/08/2023] [Accepted: 01/11/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE The objective of this study was to determine the role of body fat percentage (BFP) changes in diabetes remission (DR) and the association between baseline body composition and its changes after bariatric surgery. METHODS We analyzed 203 patients with type 2 diabetes who underwent Roux-en-Y gastric bypass. Body composition was measured using a gold-standard-derived predictive equation and magnetic resonance imaging. Body composition changes were calculated as 100 × (baseline value - follow-up value)/baseline value. We verified the results in a laparoscopic sleeve gastrectomy cohort with 311 patients. RESULTS Compared with non-remission patients in the Roux-en-Y gastric bypass cohort, those who achieved DR showed a higher baseline fat-free mass index (FFMI) and experienced the most significant changes in BFP (p < 0.001). In comparative analyses, BFP changes were significantly better than BMI changes in identifying short- and long-term DR. Linear regression analysis identified FFMI as the most significant baseline variable correlated with BFP changes (p < 0.001). Baseline BMI was positively correlated with changes in BFP but negatively correlated with changes in FFMI. These findings were replicated in the laparoscopic sleeve gastrectomy cohort. CONCLUSIONS BFP changes determine DR after bariatric surgery, and baseline FFMI is crucial for BFP changes. A low initial BMI is associated with a smaller BFP reduction and greater FFMI loss after bariatric surgery.
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Affiliation(s)
- Shaobo Li
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianzhong Di
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Di Yang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Rongrong Xu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yunfeng Xiao
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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8
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Simoneau M, McKay B, Brooks E, Doucet É, Baillot A. Gut peptides before and following Roux-En-Y gastric bypass: A systematic review and meta-analysis. Obes Rev 2024; 25:e13702. [PMID: 38327045 DOI: 10.1111/obr.13702] [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] [Received: 11/22/2022] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
A systematic search was conducted in Medline Ovid, Embase, Scopus, and Cochrane Central Register of Controlled Trials up until March 2021 following PRISMA guidelines. Studies included evaluated ghrelin, GLP-1, PYY or appetite sensation via visual analogue scales (VASs) before and after Roux-en-Y gastric bypass (RYGB) in adults. A multilevel model with random effects for study and follow-up time points nested in study was fit to the data. The model included kcal consumption as a covariate and time points as moderators. Among the 2559 articles identified, k = 47 were included, among which k = 19 evaluated ghrelin, k = 40 GLP-1, k = 22 PYY, and k = 8 appetite sensation. Our results indicate that fasting ghrelin levels are decreased 2 weeks post-RYGB (p = 0.005) but do not differ from baseline from 6 weeks to 1-year post-RYGB. Postprandial ghrelin and fasting GLP-1 levels were not different from pre-surgical values. Postprandial levels of GLP-1 increased significantly from 1 week (p < 0.001) to 2 years post-RYGB (p < 0.01) compared with pre-RYGB. Fasting PYY increased at 6 months (p = 0.034) and 1 year (p = 0.029) post-surgery; also, postprandial levels increased up to 1 year (p < 0.01). Insufficient data on appetite sensation were available to be meta-analyzed.
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Affiliation(s)
- Mylène Simoneau
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Brad McKay
- Department of kinesiology, University of McMaster, Hamilton, Ontario, Canada
| | - Emma Brooks
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Éric Doucet
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Aurélie Baillot
- Department of nursing, University of Québec en Outaouais, Gatineau, Quebec, Canada
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9
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Moyad MA. Embracing the Pros and Cons of the New Weight Loss Medications (Semaglutide, Tirzepatide, Etc.). Curr Urol Rep 2023; 24:515-525. [PMID: 37659049 DOI: 10.1007/s11934-023-01180-7] [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] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE OF REVIEW The history of multiple weight loss medications has been a concerning paradox based on an increased cardiovascular risk despite significant reductions in adipose tissue and weight. A new class of weight loss medications could change this past narrative based on early preliminary results of cardiovascular risk (not events-still need to be determined) and weight reduction in non-diabetics that acutely competes with results achieved with bariatric surgery. The purpose of this review is to provide a comprehensive summary of the advantages and disadvantages of these newer medications, and how they could impact urology. RECENT FINDINGS Weight loss of - 15 to - 20% compared to baseline has become plausible in the short-term and preliminary guidance to reduce acute and chronic adverse events are receiving attention. However, the cost, access, conflicts of interest, supply chain, life-long adherence issues, and the long-term diverse implications on mental and physical health when exposed to this class of medications (GLP-1 agonists) are unknown. The profound caloric reductions should also result in baseline or ongoing nutritional deficiency testing, and general and specific dietary recommendations, which could theoretically mimic some bariatric surgery pre- and post-surgical protocols but has yet to be studied. Regardless, the potential impact of these medicines within a variety of medical specialties needs clinical research. Current and future lifestyle interventions, dietary patterns, and medicines in the weight loss category need to be held to a paradigm whereby cardiovascular health should improve with significant weight loss without a negative impact on mental health. In urology, the ability to impact cancer risk, ED, FSD, incontinence, infertility, nephrolithiasis, and multiple other endpoints are plausible (based on bariatric surgery data) but need preliminary clinical research. Other medicines with a similar or even larger potential impact are in clinical trials, and thus, a concise overview for clinicians and researchers was needed for objective guidance. Currently, comprehensive lifestyle changes utilized with and without these medications continue to garner positive mental, physical, and legacy effects, which suggest that they are as necessary as ever in the treatment of the numerous conditions impacted by unhealthy weight gain.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA.
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10
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Mantziari S, Abboretti F, Favre L, Thomopoulos T, Barigou M, Demartines N, Suter M. Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature. Surg Obes Relat Dis 2023; 19:746-754. [PMID: 36702647 DOI: 10.1016/j.soard.2022.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
Although protein malnutrition (PM) is often reported after highly malabsorptive procedures, its exact incidence and mechanisms after Roux-en-Y gastric bypass (RYGB) are poorly understood. The aim of this study was to present a challenging clinical case of PM after RYGB and conduct a scoping review of the literature. Among the 18 studies with 3015 RYGB patients included in the review, the median incidence of PM was 1.7% (range, 0%-8.9%), and it was diagnosed 12 to 120 months after RYGB. The most common cause is insufficient oral intake of protein; however, in cases of persistent hypoalbuminemia, a thorough diagnostic workup needs to be performed. Risk factors for PM after RYGB include specific triggering events such as intractable vomiting and dysphagia, and a total alimentary limb length less than 250 to 300 cm.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Lucie Favre
- Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland; Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Theodoros Thomopoulos
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mohammed Barigou
- Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland.
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11
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Boniecka I, Czerwonogrodzka-Senczyna A, Jeznach-Steinhagen A, Paśnik K, Szostak-Węgierek D, Zeair S. Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients. Nutrients 2023; 15:nu15112479. [PMID: 37299442 DOI: 10.3390/nu15112479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.
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Affiliation(s)
- Iwona Boniecka
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | | | - Anna Jeznach-Steinhagen
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Samir Zeair
- Department of General, Vascular and Transplantation Surgery, Marie Curie Hospital, 71-455 Szczecin, Poland
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12
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Reichmann MTF, Duarte A, Ivano F, Campos ACL. Evolution of the basal metabolic rate after Roux-en-Y gastric bypass: a systematic review and meta-analysis. Updates Surg 2023:10.1007/s13304-023-01523-6. [PMID: 37145227 DOI: 10.1007/s13304-023-01523-6] [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: 01/21/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
Patients who undergo Roux-en-Y gastric bypass (RYGB) exhibit a reduction in total basal metabolic rate (BMR) after surgery, which seems to be intimately related to the amount of postoperative weight loss. The objective was to perform a systematic review and meta-analysis of the literature to determine and evaluate BMR changes after RYGB. The search was performed in certified databases, and the strategy was structured according to the PRISMA ScR. The quality evaluation of the articles included in this review was assessed with two different bias risk tools (ROBINS-I and NIH) according to each study design. Two meta-analyses were elaborated based on the results. 163 articles were selected (from 2016 to 2020), and 9 articles met the inclusion criteria. All of the selected studies evaluated only adult patients, mostly women. Postoperative BMR diminished in all of the included studies after surgery compared to preoperative values. The follow-up periods were 6, 12, 24 and 36 months. Eight articles were used for the meta-analysis after the quality assessment, a total of 434 participants. Compared to baseline values, mean postoperative reductions of 356.66 kcal/d after 6 months (p < 0.001) and 432.89 kcal/d (p < 0.001) after 1 year were observed. The BMR decreases during the first years after Roux-en-Y gastric bypass, especially during the first year postsurgery.
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Affiliation(s)
- Michelle T F Reichmann
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil.
| | - Alexia Duarte
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil
| | - Flavio Ivano
- Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, PR, Brazil
| | - Antonio Carlos L Campos
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil
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13
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Gero D, Bueter M. Post-bariatric changes in ingestive behavior: Shift in macronutrient preferences in rats and dynamic adaptation of the within-meal microstructure in humans. Physiol Behav 2023; 263:114113. [PMID: 36764423 DOI: 10.1016/j.physbeh.2023.114113] [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: 12/18/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
This invited review is based on a presentation given at the Annual Meeting of the Society for the Study of Ingestive Behavior in July 2022 and provides the summary of two recent studies on changes in ingestive behavior following bariatric surgery (BS). First, long-term changes in daily absolute and relative macronutrient intake are reported in a rodent model of Roux-en-Y gastric bypass (RYGB). Rats undergoing RYGB progressively decreased their daily calorie- and daily fat intake compared to their preoperative baseline and to the intake of sham operated animals. Second, postbariatric changes in the within-meal ingestive microstructure are portrayed, based on longitudinal data collected in RYGB patients using a drinkometer. The post-RYGB meal size showed a dynamic adjustment process, with the highest decrease in the early postoperative phase, followed by a steady convalescence up to 1-year, at which point the meal size of RYGB patients became comparable to the normal weight adults'. Results are contextualized and contrasted to recent reports on the effect of BS on taste and food choices and consumption. The showcased evidence supports the role of ingestive adaptation and learning in the achievement of reduced calorie intake after RYGB, both in humans and in rodents. The reorganized upper-gastrointestinal anatomy supposedly leads to increased postingestive caloric sensibility, which might be an important behavioral mediator of decreased postbariatric meal size and consequent weight loss.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Surgery, Männedorf Hospital, Männedorf, Switzerland.
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14
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Abstract
Brown adipose tissue (BAT) displays the unique capacity to generate heat through uncoupled oxidative phosphorylation that makes it a very attractive therapeutic target for cardiometabolic diseases. Here, we review BAT cellular metabolism, its regulation by the central nervous and endocrine systems and circulating metabolites, the plausible roles of this tissue in human thermoregulation, energy balance, and cardiometabolic disorders, and the current knowledge on its pharmacological stimulation in humans. The current definition and measurement of BAT in human studies relies almost exclusively on BAT glucose uptake from positron emission tomography with 18F-fluorodeoxiglucose, which can be dissociated from BAT thermogenic activity, as for example in insulin-resistant states. The most important energy substrate for BAT thermogenesis is its intracellular fatty acid content mobilized from sympathetic stimulation of intracellular triglyceride lipolysis. This lipolytic BAT response is intertwined with that of white adipose (WAT) and other metabolic tissues, and cannot be independently stimulated with the drugs tested thus far. BAT is an interesting and biologically plausible target that has yet to be fully and selectively activated to increase the body's thermogenic response and shift energy balance. The field of human BAT research is in need of methods able to directly, specifically, and reliably measure BAT thermogenic capacity while also tracking the related thermogenic responses in WAT and other tissues. Until this is achieved, uncertainty will remain about the role played by this fascinating tissue in human cardiometabolic diseases.
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Affiliation(s)
- André C Carpentier
- Correspondence: André C. Carpentier, MD, Division of Endocrinology, Faculty of Medicine, University of Sherbrooke, 3001, 12th Ave N, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Denis P Blondin
- Division of Neurology, Department of Medicine, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada
| | | | - Denis Richard
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, G1V 4G5, Canada
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15
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Associations of age, sex, and socioeconomic status with adherence to guideline recommendations on protein intake and micronutrient supplementation in patients with sleeve gastrectomy or Roux-en-Y gastric bypass. PLoS One 2023; 18:e0282683. [PMID: 36867644 PMCID: PMC9983924 DOI: 10.1371/journal.pone.0282683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Patients with bariatric surgery often show poor long-term compliance to recommendations for prevention of nutrient deficiency but it is unclear which factors contribute. We investigated the associations of age, sex, and socioeconomic status (SES) with adherence to guideline recommendations on protein intake and micronutrient supplementation. METHODS In a monocentric cross-sectional study we prospectively recruited patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) and a minimum postoperative period of 6 months. Clinical and demographic data were obtained from the patients' medical files and by questionnaire. Patients reported on supplement usage, recorded their dietary intake for seven days and underwent physical examinations including blood testing. RESULTS We included 35 patients (SG: n = 25, RYGB: n = 10) with a mean (+SD) postoperative period of 20.2 (±10.4) months. Distributions of age, sex and SES were comparable between the SG and RYGB groups. Non-adherence to recommended protein intake was associated with age ≥ 50 years (p = 0.041) but not sex or SES. Protein intake inversely correlated with markers of obesity. There were no significant associations of age or sex with micronutrient supplementation. Only for vitamins A (p = 0.049) and B1 (p = 0.047) higher SES was associated with greater compliance. The only manifest deficiency associated with non-adherence to micronutrient supplementation was that for folic acid (p = 0.044). CONCLUSION In patients after bariatric surgery, those of older age and of lower SES might have a greater risk of unfavorable outcome and may require greater attention to micronutrient and protein supplementation.
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Vieira FT, Godziuk K, Lamarca F, Melendez-Araújo MS, Lima RM, Prado CM, de Carvalho KMB, Dutra ES. Sarcopenic obesity diagnosis by different criteria mid-to long-term post-bariatric surgery. Clin Nutr 2022; 41:1932-1941. [DOI: 10.1016/j.clnu.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
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17
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Vieira FT, de Oliveira GS, Gonçalves VSS, Neri SGR, de Carvalho KMB, Dutra ES. Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests. PLoS One 2022; 17:e0269699. [PMID: 35687555 PMCID: PMC9187088 DOI: 10.1371/journal.pone.0269699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges' g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41-1.01; I2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84-1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20-1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06-0.87; I2 = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42-0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.
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Affiliation(s)
| | | | | | - Silvia G. R. Neri
- Graduate Program in Physical Education of the University of Brasilia, Brasilia, Brazil
| | | | - Eliane Said Dutra
- Graduate Program in Human Nutrition of the University of Brasilia, Brasilia, Brazil
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Hong YR, Yadav S, Suk R, Lee AM, Newsome FA, Johnson-Mann CN, Cardel MI, Ross KM. Assessment of Physical Activity and Healthy Eating Behaviors Among US Adults Receiving Bariatric Surgery. JAMA Netw Open 2022; 5:e2217380. [PMID: 35708688 PMCID: PMC9204540 DOI: 10.1001/jamanetworkopen.2022.17380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Bariatric surgery effectively treats severe obesity and metabolic diseases. However, individual outcomes vary depending on sustainable lifestyle change. Little is known about lifestyle patterns after bariatric surgery among the US population. OBJECTIVE To compare the level of physical activity and eating behavior among postbariatric surgery patients, individuals eligible for surgery, and those with normal weight. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study using nationally representative survey data from National Health and Nutrition Examination Survey 2015-2018. Respondents included for analysis were age 18 years or older, and categorized by individuals with normal weight, individuals who received bariatric surgery, and individuals clinically eligible for bariatric surgery. Analyses were performed from February to October 2021. MAIN OUTCOMES AND MEASURES Self-reported measures were used to assess physical activity (moderate-to-vigorous physical activity [MVPA], sedentary activity, and whether PA guidelines were met) and eating behaviors (total energy intake and Healthy Eating Index [HEI]-2015 diet quality scores). RESULTS Of 4659 study participants (mean [SD] age, 46.1 [18.6] years; 2638 [weighted percentage, 58.8%] women; 1114 [weighted percentage, 12.7%] Black, 1570 [weighted percentage, 68.6%] White), 132 (3.7%) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was 7 (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in MVPA than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (95% CI, 40.8% to 52.4%) reported meeting PA guidelines, almost 2 times higher than those in the bariatric surgery (23.1%; 95% CI, 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 95% CI, 15.6% to 25.1%). Propensity-score weighted overall HEI was higher for individuals with normal weight (54.4; 95% CI, 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 95% CI, 47.2 to 52.9) or were eligible for the surgery (48.0; 95% CI, 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d). CONCLUSIONS AND RELEVANCE In this cross-sectional study, individuals who underwent bariatric surgery had beneficial lifestyle patterns compared with those eligible for surgery; however, these improvements seemed suboptimal based on the current guidelines. Efforts are needed to incorporate benefits of physical activity and a healthy, balanced diet in postbariatric care.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida, Gainesville
- University of Florida Health Cancer Center, Gainesville
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida, Gainesville
| | - Ryan Suk
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Alexandra M. Lee
- Department of Kinesiology, Pennsylvania State University, University Park
| | - Faith A. Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
| | | | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
- WW International, Inc, New York, New York
| | - Kathryn M. Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions University of Florida, Gainesville
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Ismaeil A, Gero D, Boyle CN, Alceste D, Taha O, Spector AC, Lutz TA, Bueter M. Early Postoperative Exposure to High-Fat Diet Does Not Increase Long-Term Weight Loss or Fat Avoidance After Roux-en-Y Gastric Bypass in Rats. Front Nutr 2022; 9:834854. [PMID: 35495960 PMCID: PMC9044042 DOI: 10.3389/fnut.2022.834854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bariatric surgery alters food preferences in rats and reportedly decreases desire to consume high-fat high-sugar food in humans. The aim of this study was to investigate whether early post-operative exposure to high-fat food could increase body weight loss after Roux-en-Y gastric bypass (RYGB) by triggering fat avoidance. Methods Male Wistar rats underwent either RYGB (n = 15) or sham-operations (n = 16). Preoperatively a standardized 4-choice cafeteria diet [dietary options: low-fat/low-sugar (LFLS), low-fat/high-sugar (LFHS), high-fat/low-sugar (HFLS), high-fat/high-sugar (HFHS)] was offered. First, each option was available for 4 days, thereafter rats were offered the 4 options simultaneously for 3 days preoperatively. Post-surgery, 8 rats in the RYGB- and 8 in the sham-group were exposed to a high-fat content diet (Oatmeal + 30% lard, OM+L) for 10 days, while 7 RYGB rats and 8 sham-rats received OM alone. From the 11th postoperative day, the 4-choice cafeteria diet was reintroduced for 55-days. The intake of all available food items, macronutrients and body weight changes were monitored over 8 weeks. Main outcomes were long-term body-weight and daily change in relative caloric intake during the postoperative cafeteria period compared to the preoperative cafeteria. Results During the first 12 days of postoperative cafeteria access, RYGB-rats exposed to OM+L had a higher mean caloric intake per day than RYGB rats exposed to OM alone (Δ10 kCal, Padj = 0.004), but this difference between the RYGB groups disappeared thereafter. Consequently, in the last 33 days of the postoperative cafeteria diet, the mean body weight of the RYGB+OM+L group was higher compared to RYGB+OM (Δ51 g, Padj < 0.001). RYGB rats, independently from the nutritional intervention, presented a progressive decrease in daily consumption of calories from fat and increased their daily energy intake mainly from non-sugar carbohydrates. No such differences were detected in sham-operated controls exposed to low- or high fat postoperative interventions. Conclusion A progressive decrease in daily fat intake over time was observed after RYGB, independently from the nutritional intervention. This finding confirms that macronutrient preferences undergo progressive changes over time after RYGB and supports the role of ingestive adaptation and learning. Early postoperative exposure to high-fat food failed to accentuate fat avoidance and did not lead to superior weight loss in the long-term.
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Affiliation(s)
- Aiman Ismaeil
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Department of General Surgery, Aswan University Hospital, Aswan, Egypt
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christina N. Boyle
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Osama Taha
- Department of Plastic Surgery, Assiut University Hospital, Asyut, Egypt
| | - Alan C. Spector
- Program in Neuroscience, Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Thomas A. Lutz
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Marco Bueter,
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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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21
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Zhou N, Scoubeau C, Forton K, Loi P, Closset J, Deboeck G, Moraine JJ, Klass M, Faoro V. Lean Mass Loss and Altered Muscular Aerobic Capacity after Bariatric Surgery. Obes Facts 2022; 15:248-256. [PMID: 35086094 PMCID: PMC9021623 DOI: 10.1159/000521242] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients undergoing weight loss surgery do not improve their aerobic capacity or peak oxygen uptake (VO2peak) after bariatric surgery and some still complain about asthenia and/or breathlessness. We investigated the hypothesis that a post-surgery muscular limitation could impact the ventilatory response to exercise by evaluating the post-surgery changes in muscle mass, strength, and muscular aerobic capacity, measured by the first ventilatory threshold (VT). METHODS Thirteen patients with obesity were referred to our university exercise laboratory before and 6 months after bariatric surgery and were matched by sex, age, and height to healthy subjects with normal weight. All subjects underwent a clinical examination, blood sampling, and body composition assessment by dual-energy X-ray absorptiometry, respiratory and limb muscle strength assessments, and cardiopulmonary exercise testing on a cyclo-ergometer. RESULTS Bariatric surgery resulted in a loss of 34% fat mass, 43% visceral adipose tissue, and 12% lean mass (LM) (p < 0.001). Absolute handgrip, quadriceps, or respiratory muscle strength remained unaffected, while quadriceps/handgrip strength relative to LM increased (p < 0.05). Absolute VO2peak or VO2peak/LM did not improve and the first VT was decreased after surgery (1.4 ± 0.3 vs. 1.1 ± 0.4 L min-1, p < 0.05) and correlated to the exercising LM (LM legs) (R = 0.84, p < 0.001). CONCLUSIONS Although bariatric surgery has numerous beneficial effects, absolute VO2peak does not improve and the weight loss-induced LM reduction is associated to an altered muscular aerobic capacity, as reflected by an early VT triggering early exercise hyperventilation.
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Affiliation(s)
- Na Zhou
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium,
| | - Corentin Scoubeau
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory for Biometry and Exercise Nutrition, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Kevin Forton
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Department of Cardiology, Erasmus Hospital, Brussels, Belgium
| | - Patricia Loi
- Department of Gastric Surgery, Erasmus Hospital, Brussels, Belgium
| | - Jean Closset
- Department of Gastric Surgery, Erasmus Hospital, Brussels, Belgium
| | - Gael Deboeck
- Laboratory of Rehabilitation, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Moraine
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Malgorzata Klass
- Laboratory for Biometry and Exercise Nutrition, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Applied Biology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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Nuijten MAH, Eijsvogels TMH, Monpellier VM, Janssen IMC, Hazebroek EJ, Hopman MTE. The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta-analysis. Obes Rev 2022; 23:e13370. [PMID: 34664391 PMCID: PMC9285034 DOI: 10.1111/obr.13370] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022]
Abstract
Postbariatric loss of muscle tissue could negatively affect long-term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta-analysis aimed to unravel time-dependent changes in the magnitude and progress of lean body mass (LBM), fat-free mass (FFM), and skeletal muscle mass (SMM) loss following bariatric surgery. A systematic literature search was conducted in Pubmed, Embase, and Web of Science. Fifty-nine studies assessed LBM (n = 37), FFM (n = 20), or SMM (n = 3) preoperatively and ≥1 time points postsurgery. Random-effects meta-analyses were performed to determine pooled loss per outcome parameter and follow-up time point. At 12-month postsurgery, pooled LBM loss was -8.13 kg [95%CI -9.01; -7.26]. FFM loss and SMM loss were -8.23 kg [95%CI -10.74; -5.73] and -3.18 kg [95%CI -5.64; -0.71], respectively. About 55% of 12-month LBM loss occurred within 3-month postsurgery, followed by a more gradual decrease up to 12 months. Similar patterns were seen for FFM and SMM. In conclusion, >8 kg of LBM and FFM loss was observed within 1-year postsurgery. LBM, FFM, and SMM were predominantly lost within 3-month postsurgery, highlighting that interventions to mitigate such losses should be implemented perioperatively.
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Affiliation(s)
- Malou A H Nuijten
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Eric J Hazebroek
- Departement of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Roux-en-Y Gastric Bypass and Caloric Restriction but Not Gut Hormone-Based Treatments Profoundly Impact the Hypothalamic Transcriptome in Obese Rats. Nutrients 2021; 14:nu14010116. [PMID: 35010991 PMCID: PMC8746874 DOI: 10.3390/nu14010116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hypothalamus is an important brain region for the regulation of energy balance. Roux-en-Y gastric bypass (RYGB) surgery and gut hormone-based treatments are known to reduce body weight, but their effects on hypothalamic gene expression and signaling pathways are poorly studied. METHODS Diet-induced obese male Wistar rats were randomized into the following groups: RYGB, sham operation, sham + body weight-matched (BWM) to the RYGB group, osmotic minipump delivering PYY3-36 (0.1 mg/kg/day), liraglutide s.c. (0.4 mg/kg/day), PYY3-36 + liraglutide, and saline. All groups (except BWM) were kept on a free choice of high- and low-fat diets. Four weeks after interventions, hypothalami were collected for RNA sequencing. RESULTS While rats in the RYGB, BWM, and PYY3-36 + liraglutide groups had comparable reductions in body weight, only RYGB and BWM treatment had a major impact on hypothalamic gene expression. In these groups, hypothalamic leptin receptor expression as well as the JAK-STAT, PI3K-Akt, and AMPK signaling pathways were upregulated. No significant changes could be detected in PYY3-36 + liraglutide-, liraglutide-, and PYY-treated groups. CONCLUSIONS Despite causing similar body weight changes compared to RYGB and BWM, PYY3-36 + liraglutide treatment does not impact hypothalamic gene expression. Whether this striking difference is favorable or unfavorable to metabolic health in the long term requires further investigation.
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Oliveira GS, Vieira FT, Lamarca F, Lima RM, Carvalho KMB, Dutra ES. Resistance Training Improves Muscle Strength and Function, Regardless of Protein Supplementation, in the Mid- to Long-Term Period after Gastric Bypass. Nutrients 2021; 14:14. [PMID: 35010889 PMCID: PMC8746810 DOI: 10.3390/nu14010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Inadequate protein intake and low levels of physical activity are common long-term sequelae after bariatric surgery and can negatively affect muscle strength (MS) and physical function (PF). The study investigated the effects of resistance training with or without protein supplementation on MS and PF. The study, which involved a 12-week controlled trial (n = 61) of individuals 2-7 years post-Roux-en-Y gastric bypass (RYGB), comprised four groups: whey protein supplementation (PRO; n = 18), maltodextrin placebo (control [CON]; n = 17), resistance training combined with placebo (RTP; n = 11), and resistance training combined with whey protein supplementation (RTP+PRO; n = 15). An isokinetic dynamometer was used to measure MS (peak torque at 60°/s and 180°/s). PF was measured with the 30-s sit-to-stand (30-STS), 6-min walk (6-MWT), and timed up-and-go (TUG) tests. There were improvements in the absolute and relative-to-bodyweight peak torque at 60°/s and 180°/s, TUG, 6-MWT and 30-STS in the RTP and RTP+PRO groups, but not in the CON and PRO groups. Changes in MS were significantly correlated with changes in PF between the pre- and post-intervention periods. A supervised resistance training program, regardless of protein supplementation, improved MS and PF in the mid-to-long-term period after RYGB and can lead to clinical benefits and improved quality of life.
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Affiliation(s)
- Gabriela S. Oliveira
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Flávio T. Vieira
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Fernando Lamarca
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
- Department of Applied Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-240, Brazil
| | - Ricardo M. Lima
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
- Graduate Program in Physical Education, University of Brasília, Brasília 70910-900, Brazil
| | - Kênia M. B. Carvalho
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Eliane S. Dutra
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
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Kapoor N, al Najim W, Menezes C, Price RK, O’Boyle C, Bodnar Z, Spector AC, Docherty NG, le Roux CW. A Comparison of Total Food Intake at a Personalised Buffet in People with Obesity, before and 24 Months after Roux-en-Y-Gastric Bypass Surgery. Nutrients 2021; 13:3873. [PMID: 34836130 PMCID: PMC8625776 DOI: 10.3390/nu13113873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
Long-term reductions in the quantity of food consumed, and a shift in intake away from energy dense foods have both been implicated in the potent bariatric effects of Roux-en-Y gastric bypass (RYGB) surgery. We hypothesised that relative to pre-operative assessment, a stereotypical shift to lower intake would be observed at a personalised ad libitum buffet meal 24 months after RYGB, driven in part by decreased selection of high energy density items. At pre-operative baseline, participants (n = 14) rated their preference for 72 individual food items, each of these mapping to one of six categories encompassing high and low-fat choices in combination with sugar, complex carbohydrate or and protein. An 18-item buffet meal was created for each participant based on expressed preferences. Overall energy intake was reduced on average by 60% at the 24-month buffet meal. Reductions in intake were seen across all six food categories. Decreases in the overall intake of all individual macronutrient groups were marked and were generally proportional to reductions in total caloric intake. Patterns of preference and intake, both at baseline and at follow-up appear more idiosyncratic than has been previously suggested by verbal reporting. The data emphasise the consistency with which reductions in ad libitum food intake occur as a sequel of RYGB, this being maintained in the setting of a self-selected ad libitum buffet meal. Exploratory analysis of the data also supports prior reports of a possible relative increase in the proportional intake of protein after RYGB.
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Affiliation(s)
- Natasha Kapoor
- Diabetes Complications Research Centre, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (N.K.); (W.a.N.); (C.M.); (C.W.l.R.)
| | - Werd al Najim
- Diabetes Complications Research Centre, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (N.K.); (W.a.N.); (C.M.); (C.W.l.R.)
| | - Camilo Menezes
- Diabetes Complications Research Centre, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (N.K.); (W.a.N.); (C.M.); (C.W.l.R.)
| | - Ruth K Price
- The Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine BT52 1SA, UK;
| | - Colm O’Boyle
- Department of Surgery, Bon Secours Hospital, T12 DV56 Cork, Ireland;
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, F92 AE81 Letterkenny, Ireland;
| | - Alan C Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA;
| | - Neil G Docherty
- Diabetes Complications Research Centre, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (N.K.); (W.a.N.); (C.M.); (C.W.l.R.)
| | - Carel W le Roux
- Diabetes Complications Research Centre, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (N.K.); (W.a.N.); (C.M.); (C.W.l.R.)
- Centre for Diabetes, Ulster University, Coleraine BT52 1SA, UK
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26
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Guyot E, Dougkas A, Nazare JA, Bagot S, Disse E, Iceta S. A systematic review and meta-analyses of food preference modifications after bariatric surgery. Obes Rev 2021; 22:e13315. [PMID: 34312976 DOI: 10.1111/obr.13315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analyses aimed to synthesize evidence of the link between bariatric surgery and changes in food preferences, considering the method of assessment. MEDLINE, Cochrane Library, Web of Science, Cinahl, PsychINFO, ProQuest, and Open grey were searched incorporating two blocks of terms ("Intervention" and "Food Preferences"). Interventional or observational studies involving patients (BMI ≥ 35 kg m-2 ) with sleeve gastrectomy (SG) or Roux-en-Y Gastric Bypass (RYGB) and a control group were included. Meta-analyses were performed comparing the standardized daily mean percentage energy from proteins, carbohydrates, and lipids between preoperative and postoperative patients. Fifty-seven studies concerning 2,271 patients with RYGB and 903 patients with SG met the inclusion criteria, of which 24 were eligible for meta-analysis. Despite a total reduction in macronutrient intakes, the meta-analyses revealed a postoperative increase in percentage energy from proteins at 12 months (0.24, 95% CI: 0.03, 0.46, {I2 } = 73%) and a decrease in percentage energy from fat at 1 month (-0.47, 95% CI: 0.86, 0.09, {I2 } = 72%), up to 24 months (-0.20, 95% CI: -0.31, 0.08, {I2 } = 0%). In conclusion, the present systematic review and meta-analyses showed changes of food preferences in terms of macronutrient, food selection and, overall food appreciation up to 5 years following bariatric surgery.
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Affiliation(s)
- Erika Guyot
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Institut Paul Bocuse Research Center, Ecully, France
| | | | - Julie-Anne Nazare
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Sarah Bagot
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Institut Paul Bocuse Research Center, Ecully, France
| | - Emmanuel Disse
- Centre Européen Nutrition et Santé (CENS), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Pierre-Bénite, France.,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Pierre-Bénite, France.,Department of Endocrinology, Diabetes and Nutrition, Integrated Center for Obesity, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Sylvain Iceta
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Quebec, Canada
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The Effect of Protein Consumption on Fat-Free Mass, Fat Mass, and Weight Loss 1 Year After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:4741-4748. [PMID: 34426908 DOI: 10.1007/s11695-021-05565-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) both limit protein and calorie intake and result in loss of fat-free mass (FFM), fat mass (FM), and weight. This study examined protein consumption and body composition changes after bariatric surgery. METHODS A prospective study of patients undergoing SG and RYGB between January 1 and December 31, 2016, with 1-year follow-up. Dietary, body composition, and physical activity data were collected at 3, 6, and 12 months post-operatively by bioelectric impedance and food records. Clinical laboratory data were obtained pre- and post-surgery. RESULTS One hundred and five patients (62 [59%] SG and 43 [41%] RYGB) were included in this study. Mean age was 31.8 ± 7.22 years. TWL% after 1 year in SG was 27.11% (p < 0.001) and that in RYGB was 30.41% (p < 0.0001). Reported protein consumptions after RYGB increased from 41.59 ± 22.86 g/day at 3 months (p = 0.004) to 57.90 ± 19.24 g/day at 12 months compared to 52.36 ± 25.04 g and 53.54 ± 29.75 g in SG. Similarly, energy intake after RYGB at 3 and 12 months increased from 895.9 ± 422.61 to 1188.15 ± 463.86 kcal/day compared to 1007.67 ± 422.62 to 1068 ± 575.89 kcal/day after SG (p = 0.009). There was a significant loss of fat-free mass and muscle mass in SG patients at 3 and 12 months from 61.58 ± 3.61 kg and 58.47 ± 3.09 kg to 54.18 ± 11.05 (p < 0.001) and 51.55 ± 10.62 (p = 0.004) but not in RYGB patients. Physical activity levels were similar in SG and RYGB patients. CONCLUSION There was a significant preservation of muscle mass after RYGB. Protein intake in majority of the patients was below 60 g/day during the first year after SG and RYGB.
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Legault M, Leblanc V, Marchand GB, Iceta S, Drolet-Labelle V, Lemieux S, Lamarche B, Michaud A. Evaluation of Dietary Assessment Tools Used in Bariatric Population. Nutrients 2021; 13:nu13072250. [PMID: 34210110 PMCID: PMC8308448 DOI: 10.3390/nu13072250] [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: 05/13/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 01/23/2023] Open
Abstract
Severe obesity is associated with major health issues and bariatric surgery is still the only treatment to offer significant and durable weight loss. Assessment of dietary intakes is an important component of the bariatric surgery process. Objective: To document the dietary assessment tools that have been used with patients targeted for bariatric surgery and patients who had bariatric surgery and explore the extent to which these tools have been validated. Methods: A literature search was conducted to identify studies that used a dietary assessment tool with patients targeted for bariatric surgery or who had bariatric surgery. Results: 108 studies were included. Among all studies included, 27 used a dietary assessment tool that had been validated either as part of the study per se (n = 11) or in a previous study (n = 16). Every tool validated per se in the cited studies was validated among a bariatric population, while none of the tools validated in previous studies were validated in this population. Conclusion: Few studies in bariatric populations used a dietary assessment tool that had been validated in this population. Additional studies are needed to develop valid and robust dietary assessment tools to improve the quality of nutritional studies among bariatric patients.
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Affiliation(s)
- Marianne Legault
- Quebec Heart and Lung Institute Research Centre, Université Laval, Québec City, QC G1V 4G5, Canada; (M.L.); (S.I.); (V.D.-L.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Vicky Leblanc
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Geneviève B. Marchand
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Sylvain Iceta
- Quebec Heart and Lung Institute Research Centre, Université Laval, Québec City, QC G1V 4G5, Canada; (M.L.); (S.I.); (V.D.-L.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Virginie Drolet-Labelle
- Quebec Heart and Lung Institute Research Centre, Université Laval, Québec City, QC G1V 4G5, Canada; (M.L.); (S.I.); (V.D.-L.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Simone Lemieux
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Benoît Lamarche
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
| | - Andréanne Michaud
- Quebec Heart and Lung Institute Research Centre, Université Laval, Québec City, QC G1V 4G5, Canada; (M.L.); (S.I.); (V.D.-L.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada; (V.L.); (G.B.M.); (S.L.); (B.L.)
- Correspondence:
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Nicoletti CF, Esteves GP, Genario R, Santo MA, de Cleva R, Gualano B, Roschel H. Nutritional Inadequacies Among Post-bariatric Patients During COVID-19 Quarantine in Sao Paulo, Brazil. Obes Surg 2021; 31:2330-2334. [PMID: 33231819 PMCID: PMC7683868 DOI: 10.1007/s11695-020-05107-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
Post bariatric control of food intake is influenced by psychological and behavioral factors. We investigated dietary habits and food intake during COVID-19 quarantine among recently operated patients. Patients were assessed for total and per meal energy and macronutrient intake as well as frequency of food consumption per processing level. Patients were also classified according to adherence to nutritional recommendations from our outpatient clinic. Main results are indicative of inappropriate nutritional intake during COVID-19 quarantine in postoperative bariatric patients. We observed that many patients failed to meet the recommended protein intake (89.2%) along a relatively high intake of ultra-processed foods (~1/4 of the diet). Our data suggest the need for the implementation of strategies to extend nutritional care to at-risk patients during social distancing.
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Affiliation(s)
- Carolina Ferreira Nicoletti
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, University of Sao Paulo, São Paulo, Brazil
- Department of Health Science, Ribeirão Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gabriel Perri Esteves
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Rafael Genario
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, University of Sao Paulo, São Paulo, Brazil
| | - Marco Aurélio Santo
- Department of Digestive Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Roberto de Cleva
- Department of Digestive Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, University of Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of Sao Paulo, Av. Dr Arnaldo, 455 - 3 o andar sala 3131, Sao Paulo, SP, 01246-903, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, University of Sao Paulo, São Paulo, Brazil.
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of Sao Paulo, Av. Dr Arnaldo, 455 - 3 o andar sala 3131, Sao Paulo, SP, 01246-903, Brazil.
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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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Neonatal Outcomes of Pregnancy Following Roux-en-Y Gastric Bypass: a Matched Case-Control Study. Obes Surg 2021; 30:2963-2970. [PMID: 32335867 DOI: 10.1007/s11695-020-04633-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare perinatal outcomes and to assess the predictors of birth weight (BW) after Roux-en-Y gastric bypass (RYGB) to those women unexposed to bariatric surgery. MATERIALS AND METHODS Singleton births from women submitted to RYGB (BSG) were matched to two control births by maternal age, delivery year, and gender. Control group 1 (CG1) and control group 2 (CG2) were selected according to the prepregnancy body mass index (BMI) < 35 kg/m2 and ≥ 35 kg/m2, respectively, without previous bariatric surgery. RESULTS Fifty-eight pregnancies were evaluated in each group (n = 174). Neonates born after RYGB presented lower BW compared to CG1 (mean difference - 182.3 g; 95% CI - 333; - 31, P = 0.018) and CG2 (mean difference - 306.6 g, 95% CI - 502; - 111, P = 0.02). Although gestational age (GA) was similar (P = 0.219), fetal growth rate (in grams) per gestational week was higher in CG2 (β = 196.27, P < 0.001) vs. BSG (β = 127.65, P < 0.001), irrespective of gestational weight gain (GWG). Pregnancies post-RYGB showed lower GWG, lower BW, and higher prevalence of cesarean section than CG1 and were associated with lower BW, smaller cephalic perimeter, lower prevalence of macrosomia, hypertension, and gestational diabetes than CG2. CONCLUSION Birth weight was higher in neonates from women with higher prepregnancy BMI, as compared to births from women submitted to RYGB, irrespective of GWG. Although nearly half of the RYGB mothers were classified with obesity at conception, those pregnancies were associated with better obstetric and neonatal outcomes than among women with prepregnancy BMI ≥ 35 kg/m2 who had never undergone RYGB.
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Lewis KH, Ji M, Bai Y, Arterburn DE, Bhakta BB, Cornejo M, Crawford CL, Drewnowski A, Gray MF, Moore DD, Murali SB, Paz SR, Taylor B, Yoon TK, Young DR, Coleman KJ. Bariatric Surgical Alterations in Tolerability, Enjoyment and Cravings in the Diet (BSATED) instrument: A new scale to measure food preferences following bariatric surgery. Appetite 2021; 162:105151. [PMID: 33549835 DOI: 10.1016/j.appet.2021.105151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/28/2022]
Abstract
Bariatric surgery is associated with changing food preferences, but it is not known whether these changes differ by type of operation or are associated with weight loss. The current study presents validation results for a new 27-item scale, Bariatric Surgical Alterations in Tolerability, Enjoyment and Cravings in the Diet (BSATED). This scale measured enjoyment, craving, and intolerance changes for nine food and beverage categories common to dietary habits in the Southern California region of the U.S. one year following bariatric surgery in the Bariatric Experience Long Term (BELONG) study. Validation of BSATED was done using exploratory factor analyses, construct validity with other conceptually related survey instruments, and criterion validity using hypothesized differences for operation type and percent total weight loss (%TWL) at 12-18 months after surgery. Participants (n = 999) were 86% female, 41% non-Hispanic White, with a mean age of 43.1 ± 11.3 years and a body mass index (BMI) of 43.4 ± 6.8 kg/m2 at the time of surgery. Participants reported less enjoyment and craving for high-fat meats (62%), grains (54%), candy and other desserts (e.g. candy bars, chocolate, ice cream) (52%), and sweet baked goods (48%) 12 months after surgery. These changes were more common among participants undergoing Roux-en-Y gastric bypass (RYGB) compared to those receiving sleeve gastrectomy (SG). Participants who reported decreased enjoyment and craving for foods and beverages that post-bariatric patients are counseled to reduce or avoid had greater %TWL at 12-18 months following surgery (p < .001 and p = .003 respectively). The foods and beverages in BSATED that post-bariatric patients are counseled to reduce or avoid could be used to understand how changes in enjoyment, craving and tolerability of these foods/beverages contribute to weight loss following surgery.
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Affiliation(s)
- Kristina H Lewis
- SM Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Yun Bai
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Bhumi B Bhakta
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Melissa Cornejo
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | | | - Darren D Moore
- Marriage and Family Therapy Program, Touro University Worldwide, Los Alamitos, CA, USA
| | - Sameer B Murali
- Center for Healthy Living, San Bernardino Medical Center, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Silvia R Paz
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Brianna Taylor
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Tae K Yoon
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Deborah Rohm Young
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, USA.
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Lamarca F, Vieira FT, Lima RM, Nakano EY, da Costa THM, Pizato N, Dutra ES, de Carvalho KMB. Effects of Resistance Training With or Without Protein Supplementation on Body Composition and Resting Energy Expenditure in Patients 2-7 Years PostRoux-en-Y Gastric Bypass: a Controlled Clinical Trial. Obes Surg 2021; 31:1635-1646. [PMID: 33409971 DOI: 10.1007/s11695-020-05172-1] [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] [Received: 07/04/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Resistance training (RT) and adequate protein intake are recommended as strategies to preserve fat-free mass (FFM) and resting metabolic demand after bariatric surgery. However, the effect of both interventions combined in the late postoperative period is unclear. This study investigated the effects of RT, isolated and combined with protein supplementation, on body composition and resting energy expenditure (REE) in the late postoperative period of Roux-en-Y gastric bypass (RYGB). METHODS This controlled trial involved patients who were 2-7 years postRYGB. Participants were partially matched on body mass index (BMI), age, sex, and years after surgery, and divided into four groups, placebo maltodextrin (control [CON]; n = 17), whey protein supplementation (PRO; n = 18), RT combined with placebo (RTP; n = 13), and RT combined with whey protein supplementation (RTP + PRO; n = 15)-considering the participants who completed the protocol. REE was measured by indirect calorimetry and body composition by multifrequency electrical bioimpedance. RESULTS Participant characteristics (40.3 ± 8.3 years old; average BMI 29.7 ± 5.3 kg/m2; 88.9% females) were similar among groups. The RTP+PRO group showed an increase of 1.46 ± 1.02 kg in FFM and 0.91 ± 0.64 kg in skeletal muscle mass (SMM), which was greater than the equivalent values in the CON group (- 0.24 ± 1.64 kg, p = 0.006 and - 0.08 ± 0.96 kg, p = 0.008, respectively). There was no significant time-by-group interaction for absolute or relative REE. CONCLUSION Combined RT and adequate protein intake via supplementation can increase FFM and SMM in the late postoperative period without changing REE. These associated strategies were effective in improving muscle-related parameters and potentially in improving the patients' physical function.
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Affiliation(s)
- Fernando Lamarca
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil.,Department of Applied Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio Teixeira Vieira
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Ricardo Moreno Lima
- Graduate Program in Physical Education, University of Brasília, Brasília, Brazil
| | | | - Teresa Helena Macedo da Costa
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Eliane Said Dutra
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
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Complications nutritionnelles de la chirurgie de l’obésité : prévalence, prévention, traitement. Revue systématique de littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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35
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Haghighat N, Kazemi A, Asbaghi O, Jafarian F, Moeinvaziri N, Hosseini B, Amini M. Long-term effect of bariatric surgery on body composition in patients with morbid obesity: A systematic review and meta-analysis. Clin Nutr 2020; 40:1755-1766. [PMID: 33097305 DOI: 10.1016/j.clnu.2020.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
We performed a meta-analysis to provide quantitative estimates of fat mass (FM) and fat-free mass (FFM) changes in patients following bariatric surgery over 1 year. A systematic search of PubMed, SCOPUS and Web of Science databases was conducted; the pooled weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using a random-effects model. Thirty-four studies including Roux en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) biliopancreatic diversion (BPD) and gastric banding (GB) were analyzed. RYGB decreased in body FM (-28.99 kg [31.21, -26.77]) or FM% (-12.73% [-15.14, -10.32]) or FFM (-9.97 kg [-10.93, -9.03]), which were greater than SG and GB. Moreover, the FFM% in RYGB group (11.72% [7.33, 16.11]) was more than SG (5.7% [4.44, 6.95]) and GB (8.1% [6.15, 10.05]) groups. Bariatric surgeries, especially RYGB, might be effective for a decrease in FM and maintenance of FFM in patients with morbid obesity in over 1 year.
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Affiliation(s)
- Neda Haghighat
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fateme Jafarian
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hosseini
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Amini
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Bariatric surgery affects obesity-related protein requirements. Clin Nutr ESPEN 2020; 40:392-400. [PMID: 33183568 DOI: 10.1016/j.clnesp.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT Following bariatric surgery, protein deficiency intakes are reported in morbidly obese patients, whereas post-bariatric protein requirements are not specifically defined with validated method in this population. OBJECTIVE To assess average protein requirement (APR) in obese subjects, before, 3 months and 12 months after bariatric surgery using the validated method of nitrogen balance. DESIGN AND SETTING Prospective longitudinal study conducted in 21 morbidly obese patients (BMI 43.9 ± 1.4 kg/m2) before (M0), 3 months (M3) and 12 months (M12) after sleeve gastrectomy or Roux-en-Y gastric by-pass. An additional larger cross-sectional study was performed to validate APR before surgery in non-operated matched obese patients (n = 106). APR was evaluated at M0, M3, M12 by measuring 3 days dietary intakes together with losses of nitrogen in urine and stools. MAIN OUTCOME MEASURE APR was defined as the mean value of protein intake required to achieve balance nitrogen equilibrium. RESULTS Before surgery, APR in morbidly obese patients was 0.76 [95%CI, 0.66-0.92] g/kg Body Weight (BW)/d in the experimental group, and 0.74 [0.70-0.80] g/kg BW/d in the validation group. APR was 0.62 [0.51-0.75] g/kg/d at M3 and 0.87 [0.75-0.98] g/kg/d at M12, with no difference between surgical procedures. Spontaneous protein intakes were respectively 0.80 ± 0.05, 0.43 ± 0.03 and 0.71 ± 0.04 g/kg BW/d respectively at M0, M3 and M12. CONCLUSION This study demonstrates a temporal change in protein requirement after bariatric surgery whatever the type of surgery. Spontaneous protein intakes following bariatric surgery does not cover protein requirements for most patients, suggesting that specific dietary protein recommandations have to be adapted in obese patients with bariatric surgery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01249326.
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Schoemacher LAHM, Boerboom AB, Thijsselink MMR, Aarts EO. The Relationship Between Energy Intake and Weight Loss in Bariatric Patients. Obes Surg 2020; 29:3874-3881. [PMID: 31313238 DOI: 10.1007/s11695-019-04072-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is a huge variation in weight loss outcomes between bariatric patients, possibly due to differences in caloric intake and changes in the amount physical activity. However, the association between the change in energy intake and weight loss has not yet been the subject of an extensive investigation. OBJECTIVE To explore the relationship between total energy intake and % total body weight loss (%TBWL) over a period of 4 years post-surgery. METHODS Of the 466 patients who were asked to participate, a total 135 patients were included in this study. They all underwent bariatric surgery, 54 with primary Roux-en-Y Gastric Bypass, 43 redo Roux-en-Y gastric bypass after laparoscopic gastric banding and 38 laparoscopic sleeve gastrectomy. Pre- and post-operative dietary intake and physical activity were collected for both a weekday and a weekend day. The main analysis was performed using multiple regression analyses and was adjusted for age at surgery, BMI at baseline, obstructive sleep apnoea syndrome, type of eating behaviour, change in physical activity and protein intake (g/kg body weight). RESULTS %TBWL over time, post-operative energy intake and change in physical activity did not differ between the different procedure groups (p = 0.312, p = 0.988 and p = 0.050, respectively). Change in energy intake did differ between different procedure groups (p = 0.031) and linear regression showed that this was related to total body weight loss for the fully adjusted model (β = - 0.004, p = 0.014). CONCLUSION This study showed a higher decrease in energy intake to be related with a higher %TBWL.
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Affiliation(s)
- Louella A H M Schoemacher
- Wageningen University & Research, Wageningen, The Netherlands. .,Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands.
| | - Abel B Boerboom
- Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands
| | | | - Edo O Aarts
- Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands.
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Changes in Cardiorespiratory Fitness After Gastric Bypass: Relations with Accelerometry-Assessed Physical Activity. Obes Surg 2020; 29:2936-2941. [PMID: 31073952 DOI: 10.1007/s11695-019-03932-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Exercise training optimizes cardiorespiratory fitness (CRF) after bariatric surgery, but the effect of spontaneous physical activity is not well known. This study aimed to objectively quantify changes in CRF and habitual physical activity 6 months after bariatric surgery and to examine whether change in CRF was related to change in physical activity. METHODS Secondary analyses were performed on data from women who underwent Roux-en-Y gastric bypass (RYGB) between 2010 and 2014. Measurements were performed before and 6 months after RYGB and included V̇O2peak (graded maximal exercise test on a cycle ergometer), habitual physical activity (Actigraph GT3x accelerometer worn during 7 days), and body composition (DXA absorptiometry). Changes after RYGB were analyzed using Wilcoxon signed-rank test. Relations between change in CRF and change in physical activity were analyzed with Spearman correlations adjusted on age and preoperative BMI. RESULTS Forty-five women (median [P25-P75] age, 43.0 [38.0-51.0] year; BMI, 42.6 [40.0-45.5] kg/m2) were included. Mean (SD) weight loss 6 months after RYGB was - 27.5 (7.9) kg (P < 0.001). Absolute V̇O2peak decreased by 0.35 (0.50) L/min (P < 0.001) and relative V̇O2peak tended to increase by 1.7 (5.3) mL/kg/min (P = 0.06), both with large inter-individual variability. Based on objective accelerometry data, daily steps and moderate-to-vigorous physical activity increased by 1275 (3164) steps/day and 7.6 (19.3) min/day, respectively (both P < 0.05). Change in absolute V̇O2peak was positively related to change in moderate-to-vigorous physical activity (r = 0.35; P = 0.03). CONCLUSIONS The decrease in absolute CRF observed 6 months after RYGB might be prevented by increasing habitual physical activity. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01113996.
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Auclair A, Piché ME, Biertho L, Marceau S, Poirier P. Changes in fat-free mass and muscle mass at 6 and 12 months after biliopancreatic diversion with duodenal switch surgery. Surg Obes Relat Dis 2020; 16:878-885. [PMID: 32336664 DOI: 10.1016/j.soard.2020.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited. OBJECTIVES To measure and compare the changes in fat-free mass with the changes in muscle composition after biliopancreatic diversion with duodenal switch surgery (BPD/DS). SETTING Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited. METHODS Forty patients underwent BPD/DS and 22 patients are considered as controls. Bioelectrical impedance analysis (body composition) and computed tomography scan at the midthigh and abdominal levels (muscle composition) were performed at baseline, 6, and 12 months. RESULTS At 6 and 12 months, the BPD/DS group displayed significant reduction in weight (12 months: -46.6 ± 13.5 kg) and fat-free mass (12 months: -8.2 ± 4.4 kg; both P < .001). A significant reduction in abdominal (-15 ± 8%, P < .001) and midthigh muscle areas (-18 ± 7%, P < .001) was observed during the first postoperative 6 months, followed by a plateau after 6 months (abdominal: -1 ± 5%, midthigh: -1 ± 4%, both P > .05). At 6 months, both midthigh fat-infiltrated muscle (-22 ± 10%, P < .001) and normal-density muscle (-16 ± 9%, P < .001) areas decreased. Further reduction at 12 months was only observed in the fat-infiltrated muscle (-11 ± 8%, P < .001) in comparison with an increase in the normal-density muscle area (5 ± 8%, P = .001). There was no significant change for the control group. CONCLUSIONS Reduction in muscle, assessed with computed tomography scans, occurs mostly during the first 6 months postoperatively after BPD/DS. Focus on muscle quantity as well as quality, using precise imaging methods, instead of quantifying total body lean mass, is likely to provide better assessment in body content modulation after BPD/DS.
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Affiliation(s)
- Audrey Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Canada.
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Nielsen MS, Ritz C, Wewer Albrechtsen NJ, Holst JJ, le Roux CW, Sjödin A. Oxyntomodulin and Glicentin May Predict the Effect of Bariatric Surgery on Food Preferences and Weight Loss. J Clin Endocrinol Metab 2020; 105:5722168. [PMID: 32016415 DOI: 10.1210/clinem/dgaa061] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alterations in several gastrointestinal hormones are implicated in the postoperative suppression of food intake leading to weight loss after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim was to evaluate changes in responses of gastrointestinal hormones after RYGB and SG and the associations of these changes with weight loss, energy intake, and food preferences. METHODS Forty-two subjects with severe obesity were included (32 RYGB; 10 SG). Postprandial responses of glicentin, oxyntomodulin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and ghrelin were measured before and 6 months after surgery. Energy intake and energy density were assessed before and 6 months after surgery using a buffet meal test and weight loss was assessed 18 months after surgery. RESULTS Postprandial concentrations of glicentin, oxyntomodulin, GLP-1, and ghrelin differed between RYGB and SG (all P ≤ .02). Enhanced responses of glicentin and oxyntomodulin predicted a greater weight loss (both P < .01) and were associated with a larger decrease in energy density (P ≤ .04). No associations were found for GLP-1, PYY, and ghrelin, and changes were not associated with changes in energy intake. When combing all hormones, 60%, 19%, and 33% of the variations in weight loss, energy intake, and energy density, respectively, could be explained. CONCLUSION Postprandial responses of gastrointestinal hormones differed between RYGB and SG. Enhanced responses of glicentin and oxyntomodulin predicted a better weight loss and were associated with a decreased preference for energy-dense foods. Replication of these results could imply an opportunity to identify patients in need of additional support after surgical treatments of obesity.
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Affiliation(s)
- Mette S Nielsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carel W le Roux
- Investigative Science, Imperial College London, London, UK
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Anders Sjödin
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Janmohammadi P, Sajadi F, Alizadeh S, Daneshzad E. Comparison of Energy and Food Intake Between Gastric Bypass and Sleeve Gastrectomy: a Meta-analysis and Systematic Review. Obes Surg 2020; 29:1040-1048. [PMID: 30610675 DOI: 10.1007/s11695-018-03663-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractObesity is a developed nutritional problem, and today, surgery is one of the approaches to cure it. A good understanding of the variations in food intake will be beneficial for sustaining long-term weight loss post-surgery and for improving nutrition care strategies. The purpose of this review was the comparison of the impact of two methods of gastric bypass (GBP) and sleeve gastrectomy (SG) on dietary intake. Databases of PubMed, Embase, Scopus, Google Scholar, and Web of science were used for the literature search up to June 2018. We concluded the studies that measured mean daily energy intake and the percent of macronutrients from total calorie intake of before and after GBP and SG. A total of 18 studies were finally included in the meta-analysis for the effect of bariatric surgery on food intake. Bariatric surgery significantly decreased energy intake by 1050.04 kcal/day (p < 0.001) compared with the baseline values of energy intake. The pooled effect of bariatric surgery on protein intake was 0.82 g/day (p = 0.004) compared with the baseline values. The pooled analysis found no significant impact of bariatric surgery on carbohydrate intake (WMD = 0.56 g/day; p = 0.40) compared with the baseline values. The pooled estimate of effect for bariatric surgery on fat intake was - 1.34 g/day (p = 0.006). This study demonstrates that bariatric surgery might be effective on energy and fat intake; however, there was no effect on carbohydrate intake.
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Affiliation(s)
- Parisa Janmohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Forough Sajadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Farias G, Silva RMO, da Silva PPP, Vilela RM, Bettini SC, Dâmaso AR, Netto BDM. Impact of dietary patterns according to NOVA food groups: 2 y after Roux-en-Y gastric bypass surgery. Nutrition 2020; 74:110746. [PMID: 32200267 DOI: 10.1016/j.nut.2020.110746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/15/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Appropriate eating habits are crucial for sustained weight loss after bariatric surgery. A qualitative analysis of food consumption in the late postoperative period of bariatric surgery is thus advisable, even more so considering the increasing consumption of obesity-impacting ultra-processed foods. OBJECTIVE This study aimed to analyze the contribution of unprocessed, processed, and ultra-processed foods 2 y after Roux-en-Y gastric bypass (RYGB). METHODS This was a prospective study performed with 32 patients undergoing RYGB. Anthropometric and food intake data were analyzed. A food intake evaluation was conducted with a focus on quantitative and qualitative analyses. The latter was performed by categorizing food according to the NOVA classification. RESULTS There was a reduction in body mass, representing an excess weight loss of 83.80 ± 24.50% at 24 months postoperatively; and a reduction in calorie intake, macronutrients, fiber, and sodium after surgery. Regarding the qualitative analysis, 6 months after RYGB the calorie intake from processed and ultra-processed food decreased from 1398.47 ± 623.82 kcal to 471.80 ± 48.94 kcal (P < 0.05). However, between 6 and 24 months postoperatively there was an increase in 60.04% of the calorie consumption of these type of food (P < 0.01). The most important finding was that the consumption of processed and ultra-processed food exceeded 50% of the total calorie intake of the diet in all periods analyzed. CONCLUSIONS RYGB promotes quick results in weight loss and a reduction of food intake, but the quality of food may affect long-term prognosis and deserves attention in the population studied. These results highlight the importance of dietary counseling aimed at guiding better food choices, in the interest of promoting sustained weight loss after bariatric surgery.
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Affiliation(s)
- Gisele Farias
- Gastrointestinal Surgery Service of Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil; Departament of Nutrition, Faculdade Paranaense, Curitiba, Brazil.
| | | | | | | | - Solange Cravo Bettini
- Gastrointestinal Surgery Service of Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ana Raimunda Dâmaso
- Nutrition Post Graduate Program, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
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Dischinger U, Hasinger J, Königsrainer M, Corteville C, Otto C, Fassnacht M, Hankir M, Seyfried FJD. Toward a Medical Gastric Bypass: Chronic Feeding Studies With Liraglutide + PYY 3-36 Combination Therapy in Diet-Induced Obese Rats. Front Endocrinol (Lausanne) 2020; 11:598843. [PMID: 33551994 PMCID: PMC7862770 DOI: 10.3389/fendo.2020.598843] [Citation(s) in RCA: 4] [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: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Combination therapies of anorectic gut hormones partially mimic the beneficial effects of bariatric surgery. Thus far, the effects of a combined chronic systemic administration of Glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine 3-36 (PYY3-36) have not been directly compared to Roux-en-Y gastric bypass (RYGB) in a standardized experimental setting. METHODS High-fat diet (HFD)-induced obese male Wistar rats were randomized into six treatment groups: (1) RYGB, (2) sham-operation (shams), (3) liraglutide, (4) PYY3-36, (5) PYY3-36+liraglutide (6), saline. Animals were kept on a free choice high- and low-fat diet. Food intake, preference, and body weight were measured daily for 4 weeks. Open field (OP) and elevated plus maze (EPM) tests were performed. RESULTS RYGB reduced food intake and achieved sustained weight loss. Combined PYY3-36+liraglutide treatment led to similar and plateaued weight loss compared to RYGB. Combined PYY3-36+liraglutide treatment was superior to PYY3-36 (p ≤ 0.0001) and liraglutide (p ≤ 0.05 or p ≤ 0.01) mono-therapy. PYY3-36+liraglutide treatment and RYGB also reduced overall food intake and (less pronounced) high-fat preference compared to controls. The animals showed no signs of abnormal behavior in OF or EPM. CONCLUSIONS Liraglutide and PYY3-36 combination therapy vastly mimics reduced food intake, food choice and weight reducing benefits of RYGB.
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Affiliation(s)
- Ulrich Dischinger
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
- *Correspondence: Ulrich Dischinger,
| | - Julia Hasinger
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Malina Königsrainer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Carolin Corteville
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Christoph Otto
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Mohamed Hankir
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Florian Johannes David Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
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Nielsen MS, Schmidt JB, le Roux CW, Sjödin A. Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Food Preferences and Potential Mechanisms Involved. Curr Obes Rep 2019; 8:292-300. [PMID: 31222526 DOI: 10.1007/s13679-019-00354-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Bariatric surgery leads to a substantial decrease in energy intake. It is unclear whether this decrease in energy intake is simply due to eating smaller portions of the same food items or a shift in food preference towards less energy-dense foods. This review evaluates the existing literature on changes in food preferences after bariatric surgery and the potential mechanisms involved. RECENT FINDINGS Changes in food preferences have been reported; however, the evidence is mainly based on indirect measurements, such as self-reporting. When changes in food preferences are directly assessed, results contradict previous findings, indicating that results based on self-reporting must be interpreted with caution as they do not necessarily reflect actual behaviour. However, it seems that there could be inter-individual differences in the response to surgery. Future studies investigating changes in food preferences should not only focus on direct measured of behaviour but should also consider the heterogeneity of the response after bariatric surgery.
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Affiliation(s)
- Mette S Nielsen
- Department of Nutrition, Exercise and Sports, Faculty of Science (Obesity research), University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark.
- The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
| | - Julie B Schmidt
- Department of Nutrition, Exercise and Sports, Faculty of Science (Obesity research), University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - Carel W le Roux
- Investigative Science, Imperial College London, London, UK
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Anders Sjödin
- Department of Nutrition, Exercise and Sports, Faculty of Science (Obesity research), University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
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Güneş Y, Karip B, Ergin A, Esen Bulut N, Fersahoğlu MM, Memişoğlu K. The Impact of Protein Support on Weight Loss, Sarcopenia, and Quality of Life After Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Patnos State Hospital, Ağrı, Turkey
| | - Bora Karip
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Anıl Ergin
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mahir Fersahoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kemal Memişoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Benaiges D, Parri A, Subirana I, Pedro-Botet J, Villatoro M, Ramon JM, Climent E, Flores Le Roux JA, Goday A. Most of qualitative dietary changes observed one year post-bariatric surgery can be achieved with a preoperative dietary intervention. ACTA ACUST UNITED AC 2019; 67:20-27. [PMID: 31288988 DOI: 10.1016/j.endinu.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 03/21/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Bariatric surgery (BS) leads to several changes in nutritional habits that can be attributed to different mechanisms. Some of these changes could be achievable with a preoperative nutritional intervention. The objective was to evaluate dietary modifications during the preoperative and postoperative periods of BS. METHODS Prospective observational study of patients who underwent BS between 2010 and 2014 at the Hospital del Mar; 60 consecutive patients were included. Food consumption was measured by a validated food-frequency questionnaire at inclusion in the bariatric surgery program, after preoperative nutritional intervention, and one year after surgery. Generalized estimating equation models were used to assess differences in food group intake during follow up. RESULTS Energy intake significantly decreased from inclusion to 1 year of surgery (p=0.003). After the preoperative intervention and prior to surgery, there was an increase in intake of nuts, vegetables, poultry and rabbit, fruit, fish and skimmed milk products and a decrease in bread, soft drinks and pastry. At one year post-surgery, a continued decrease in the consumption of bread and soft drinks and an increase in nuts was observed (linear non-quadratic trend). Consumption of fruit, pastry, fish and skimmed milk products remained stable showing a linear and quadratic trend. Vegetables and poultry and rabbit increased in the preoperative period and decreased after surgery, showing a quadratic but not linear trend. CONCLUSIONS a preoperative nutritional intervention in morbidly obese patients can associate favorable dietary changes that are mostly maintained one year after bariatric surgery.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Alejandra Parri
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; PhD Research Program in Dietetics and Nutrition (EEES 101105 Nutrició i salut), Barcelona University, Barcelona, Spain
| | - Isaac Subirana
- Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain; CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Catalonia, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | | | - Jose M Ramon
- Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca IMIM-Hospital del Mar, Barcelona, Spain
| | - Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Juana A Flores Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Alberto Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Spain
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Adil MT, Jain V, Rashid F, Al-Taan O, Al-Rashedy M, Jambulingam P, Whitelaw D. Meta-analysis of the effect of bariatric surgery on physical activity. Surg Obes Relat Dis 2019; 15:1620-1631. [PMID: 31358394 DOI: 10.1016/j.soard.2019.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/20/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity leads to impairment of physical activity as measured by an inability to perform activities of daily living. Literature on the effect of bariatric surgery on physical activity is conflicting. OBJECTIVE The aim of this study was to perform a meta-analysis of the effect of bariatric surgery on physical activity from studies employing objective measurement and self-reporting of physical activity before and after bariatric surgery. METHODS Bibliographic databases were searched systematically for relevant literature until December 31, 2018. Studies employing objective and self-reported measurement of physical activity were included. Study quality was assessed using Risk of Bias in Nonrandomized Studies - of Interventions tool. Meta-analysis was performed using random effects model and presented as standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS Twenty studies identified 5886 patients suitable for the analysis. Physical activity showed significant improvement at 0-6 months (SMD: .50; 95% CI: .25-.76; P = .0001), >6-12 months (SMD: .58; 95% CI: .26-.91; P = .0004), and >12-36 months (SMD: .82; 95% CI: .27-1.36; P = .004) after bariatric surgery. Self-reported assessment after bariatric surgery showed significant improvement at 0-6 months (SMD: .65; 95% CI: .29-1.01; P = .0004), >6 to 12 months (SMD: .53; 95% CI: .18-.88; P = .003), and >12-36 months (SMD: .51; 95% CI: .46-.55; P < .00001). Objective assessment after bariatric surgery did not show improvement at 0-6 months (SMD: .31; 95%CI:-.05-.66; P = .09), but showed significant improvement at >6-12 months (SMD: .85; 95% CI:-.07-1.62; P = .03), and >12-36 months (SMD: 1.99; 95% CI: 1.13-2.86; P < .00001) after bariatric surgery. CONCLUSIONS Bariatric surgery improves physical activity significantly in a population with obesity up to 3 years after surgery. Objective measurement of physical activity does not show significant improvement within 6 months of bariatric surgery but begins to improve at >6 months. Self-reported measurement of physical activity begins to show improvement within 6 months of a bariatric procedure.
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Affiliation(s)
- Md Tanveer Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Farhan Rashid
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Omer Al-Taan
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Mohammad Al-Rashedy
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Periyathambi Jambulingam
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Douglas Whitelaw
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
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Lamarca F, Melendez-Araújo MS, Porto de Toledo I, Dutra ES, de Carvalho KMB. Relative Energy Expenditure Decreases during the First Year after Bariatric Surgery: A Systematic Review and Meta-Analysis. Obes Surg 2019; 29:2648-2659. [DOI: 10.1007/s11695-019-03934-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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49
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Vieira FT, Faria SLCM, Dutra ES, Ito MK, Reis CEG, da Costa THM, de Carvalho KMB. Perception of Hunger/Satiety and Nutrient Intake in Women Who Regain Weight in the Postoperative Period After Bariatric Surgery. Obes Surg 2019; 29:958-963. [PMID: 30565102 DOI: 10.1007/s11695-018-03628-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the perception of hunger and satiety and its association with nutrient intake in women who regain weight in the postoperative period after bariatric surgery. METHODS Cross-sectional study of adult women divided into three groups: weight regain (n = 20), stable weight (n = 20) (both at least 24 months after Roux-en-Y gastric bypass surgery), and non-operated obesity (n = 20). A visual analogue scale measured hunger/satiety perception while fasting, immediately after finishing a test meal, and 180 min after finishing the test meal. The incremental area above or under the curve was calculated. Food intake was analyzed by 3 days of food recall and adjusted for intraindividual variation. To make between-group comparisons, Mann-Whitney, ANOVA, Kruskal-Wallis, and independent-samples T tests and Pearson's correlation were used. RESULTS There were no between-group differences in incremental areas of hunger/satiety, but protein intake was significantly lower among patients who regained weight compared with those who had stable body weight (0.99 ± 0.23 g/kg body weight vs. 1.17 ± 0.21 g/kg body weight, p = 0.047). In the group that regained weight, satiety was correlated positively with usual dietary protein density (r = 0.541; p = 0.017) and negatively with usual carbohydrate intake (r = - 0.663; p = 0.002). CONCLUSION Women who regained weight presented similar perceptions of hunger/satiety to those of patients without weight regain and with non-operated obesity. In patients who regained weight postoperatively, satiety perception was correlated positively with usual dietary protein density and inversely with usual carbohydrate intake.
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Affiliation(s)
| | | | - Eliane Said Dutra
- Graduate Program in Human Nutrition of the University of Brasilia, Brasilia, Brazil
| | - Marina Kiyomi Ito
- Graduate Program in Human Nutrition of the University of Brasilia, Brasilia, Brazil
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Delgado André L, Basso-Vanelli RP, Di Thommazo-Luporini L, Angélica Ricci P, Cabiddu R, Pilon Jürgensen S, Ricardo de Oliveira C, Arena R, Borghi-Silva A. Functional and systemic effects of whole body electrical stimulation post bariatric surgery: study protocol for a randomized controlled trial. Trials 2018; 19:597. [PMID: 30382930 PMCID: PMC6211515 DOI: 10.1186/s13063-018-2844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Background Obesity represents a major public health problem and is the fifth leading risk factor for mortality. Morbid obesity is associated with chronic systemic inflammation which increases the risk of comorbidities. Bariatric surgery (BS) is considered an effective intervention for obese patients. However, BS is associated with dietary restriction, potentially limiting physical activity. Whole-body neuromuscular electrical stimulation (WBS) could represent an innovative option for the rehabilitation of BS patients, especially during the early postoperative phase when other conventional techniques are contraindicated. WBS is a safe and effective tool to combat sarcopenia and metabolic risk as well as increasing muscle mass, producing greater glucose uptake, and reducing the proinflammatory state. Therefore, the objective of this study is to evaluate the effects of WBS on body composition, functional capacity, muscle strength and endurance, insulin resistance, and pro- and anti-inflammatory circulating markers in obese patients undergoing BS. Methods/design The present study is a randomized, double-blind, placebo-controlled, parallel groups clinical trial approved by the Ethics Committee of our Institution. Thirty-six volunteers (body mass index (BMI) > 35 kg/m2) between 18 and 45 years of age will be randomized to the WBS group (WBSG) or control (Sham) group (ShamG) after being submitted to BS. Preoperative assessments will include maximal and submaximal exercise testing, body composition, blood inflammatory markers, and quadriceps strength and endurance. The second day after discharge, body composition will be evaluated and a 6-min walk test (6MWT) will be performed. The WBS or Sham protocol will consist of 30 daily sessions for 6 consecutive weeks. Afterwards, the same assessments that were performed in the preoperative period will be repeated. Discussion Considering the important role of WBS in skeletal muscle conditioning and its value as an aid in exercise performance, the proposed study will investigate this technique as a tool to promote early rehabilitation in these patients, and as a strategy to enhance exercise capacity, weight loss, and peripheral muscle strength with positive systemic effects. The present study is still ongoing, and data will be published after its conclusion. Trial registration REBEC, RBR-99qw5h. Registered on 20 February 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2844-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Delgado André
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Renata P Basso-Vanelli
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Luciana Di Thommazo-Luporini
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Paula Angélica Ricci
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Ramona Cabiddu
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Soraia Pilon Jürgensen
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Claudio Ricardo de Oliveira
- Department of Medicine, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil.
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