Improving the awareness and clinical practices of healthcare professionals (original) (raw)
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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2015
Background : Due to the increased prevalence of obesity in many countries, the number of bariatric surgeries is increasing. They are considered the most effective treatment for obesity. In the postoperative there may be difficulties with the quality of alimentation, tolerance to various types of food, as well as vomiting and regurgitation. Few surveys are available to assess these difficulties in the postoperative. Aim : To perform a systematic literature review about food tolerance in patients undergoing bariatric surgery using the questionnaire "Quality of Alimentation", and compare the results between different techniques. Method : A descriptive-exploratory study where the portals Medline and Scielo were used. The following headings were used in english, spanish and portuguese: quality of alimentation, bariatric surgery and food tolerance. A total of 88 references were found, 14 used the questionnaire "Quality of Alimentation" and were selected. Results : In t...
Obesity Surgery, 2014
Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin–mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.
Prevention and treatment of nutritional complications after bariatric surgery
The Lancet Gastroenterology & Hepatology, 2021
We identified references through searches of PubMed, MEDLINE and Embase using the following terms ("nutritional OR malnutrition OR deficiency OR neuropathy OR anemia OR hypoglycemia OR bone OR oxalate OR liver OR complications") AND ("bariatric surgery") from the opening date of the databases to 1st March 2020. Articles were also identified through searches in the authors' files. Only papers published in English were included. We selected and reviewed the articles describing long-term nutritional and metabolic complications after bariatric surgery. The final reference list was generated based on the novelty and relevance to the broad scope of this review.
Nutritional repercussions in patients submitted to bariatric surgery
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2015
BACKGROUND: Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. AIM: To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. METHOD: A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. RESULTS: The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After ...
Diet approach before and after bariatric surgery
Reviews in Endocrine and Metabolic Disorders
Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated p...
Nutritional Deficiencies in Bariatric Surgery Candidates
Obesity Surgery - OBES SURG, 2010
Background To assess the prevalence of nutritional deficiencies amongst people who suffer from morbid obesity and are candidates for bariatric surgery and to evaluate the relations between pre-operative nutritional deficiencies and demographic data and co-morbidities. Methods Preoperative blood tests of 114 patients (83 women and 31 men) were collected. The blood tests included plasma chemistry (including albumin, total protein, iron, ferritin, vitamin B12, folic acid, parathyroid hormone (PTH), calcium, and phosphorous) and a blood count (for hemoglobin and mean corpuscular volume (MCV)). Demographic and socio-economic details were collected from all patients. Results Mean age, weight, and BMI of the patients were 38 years (15–77), 122.9 kg (87–250), and 44.3 kg/m2 (35.3–74.9), respectively. The prevalence of pre-operative nutritional deficiencies were: 35% for iron, 24% for folic acid, 24% for ferritin, 3.6% for vitamin B12, 2% for phosphorous, and 0.9% for calcium, Hb and MCV ...
Modern Approaches to Diet Therapy of Patients before and After Bariatric Surgery
International Journal for Research in Applied Science & Engineering Technology (IJRASET), 2022
I. INTRODUCTION Currently, bariatric surgery is developing significantly as one of the most effective methods for reducing body weight. Recent studies show that metabolic surgery leads to a significant improvement in the quality of life of obese people and a decrease in their risk of death. Despite the positive effects of surgical intervention, many operated patients have new problems associated with the rapid loss of large weight. Examples include nutritional deficiencies, changes in drug pharmacokinetics, repeated weight gain, and psychological difficulties associated with changes in body constitution and dietary restriction. Therefore, a properly selected diet plays an important role both in the preoperative preparation of patients and in the postoperative recovery of the body, preventing the occurrence of such pathological processes as dumping syndrome and reactive hypoglycemia. Preoperative nutritional preparation. Despite low mortality, surgical complications (anastomotic leaks, bleeding, and infections) after bariatric interventions remain frequent (5-20%) and depend in part on factors such as age, sex, and comorbidities of the patient [3]. Therefore, careful preparation of patients for surgery is necessary, which involves the regulation of the diet in order to improve the preoperative metabolic background of the body. Over the past decades, numerous studies have been conducted that have shown that patients with severe obesity were deficient in many micronutrients compared with patients with normal body weight. Researchers analyzed the vitamin status of 110 patients with severe obesity, in whom extremely low concentrations of vitamins A, B6, C, 25-hydroxyvitamin D, and lipid-standardized vitamin E were determined [4]. Other authors examined blood sera from 200 severely obese patients and found that 38% had low iron, 24% had low folic acid, 11% had low vitamin B12, and 81% had hypovitaminosis D (with 55 %, there was a pronounced deficiency < 30 nmol/l) [1, 5]. The diet of overweight patients is most often of poor quality, diverse and high in calories, which leads to a violation of the nutritional status of the body. For example, excessive consumption of simple sugar, dairy products or fats can lead to vitamin B1 deficiency [6, 7]. In addition, it is known that inflammation of adipose tissue and increased expression of hepcidin, a systemic protein that regulates iron, can affect iron status [8]. Low-calorie and very-low-calorie diets. The need for a preoperative weight loss of 5-10% is explained by the possible difficulties that the surgeon faces during the operation, since the presence of visceral fat can increase the complexity and risk in patients with any type of abdominal surgery. Thus, laparoscopic surgery in patients with severe obesity is difficult due to the thickness of the abdominal wall, possible thickening of the mesentery and hepatomegaly. Non-alcoholic fatty liver disease (NAFLD) is a condition often complicating obesity that can lead to increased fatty liver, mainly in the left lobe, making the liver more susceptible to injury and bleeding. During laparoscopic bariatric surgery, hepatomegaly and visceral fat in the left hypochondrium may limit preexposure of the operative field, increasing the conversion rate and operative time [9]. Preoperative weight loss can be achieved with several options, such as a low calorie diet (LCD) (800-1200 kcal/day), a very low calorie diet (VLCD) (600 kcal/day), or a low calorie diet combined with intragastric balloon placement (IVB).). To date, there is no consensus on which method provides the best results in terms of weight loss, patient compliance, tolerability and acceptability. A comparable case-control study reported that intragastric balloon placement prior to gastric banding surgery significantly reduced the rate of conversions and intraoperative complications [22]. Likewise, pre-operative IVD can provide significant weight loss before bariatric surgery, being faster, cheaper, and with fewer side effects compared to IVF [18]. Theoretically, preoperative weight loss with ONCD reduces liver size and intra-abdominal fat mass, which in turn reduces blood loss, short-term complications, as well as operative time and length of hospital stay [13]. A systematic review confirmed that ONCD leads to significant weight loss (from-2.8 to-14.8 kg) and a decrease in liver size (5-20% of the initial volume), but did not find a reduction in perioperative complications [3, 10]. However, a recent study differentiating ONCD from pre-surgery NCD showed that despite the high efficiency of NCD in reducing preoperative total body weight (5.8% to 4.2%), there was no significant difference in liver volume loss. , changes in biochemical parameters, the frequency of surgical complications and length of stay in the hospital [15].
Nutritional course of patients submitted to bariatric surgery
Obesity Surgery, 2010
Background Surgical treatment has proved to be effective for weight loss, improving the quality of life of obese individuals. However, metabolic and nutritional deficiencies may occur during the late postoperative period. The objective of the present study was to assess the metabolic and nutritional profile of grade III obese individuals for 12 months after Roux-en-Y gastric bypass (RYGBP). Methods Forty-eight patients with mean body mass index (BMI) of 51.9±7.8 kg/m 2 were submitted to RYGBP. Anthropometric, food intake, and biochemical data were obtained before and for 12 months after surgery. Results There was an average weight and body fat reduction of 35% and 46%, respectively. Calorie intake was reduced, ranging from 773±206 to 1035±345 kcal during the study. Protein intake remained below recommended values throughout follow-up, corresponding to 0.5±0.3 g/kg/ current body weight/day during the 12th month. Iron and fiber intake was significantly reduced, remaining below recommended levels throughout the study. Serum cholesterol, low-density lipoprotein cholesterol, and glycemia were reduced. Albumin deficiency was present in 15.6% of subjects at the beginning of the study vs 8.9% at the end, calcium deficiency was present in 3.4% vs 16.7%, and iron deficiency was present in 12.2% vs 14.6%.
Dietary intake of female bariatric patients after anti-obesity gastroplasty
Clinics, 2006
PURPOSE: Roux-en-Y gastric bypass is a popular and successful operation for the treatment of morbid obesity. However, it greatly restricts ingestion and moderately interferes with absorption of food, thus potentially paving the way for undernutrition, especially during the first year before patients adapt to the new condition. Aiming to document actual dietary intake during this period, a prospective observational study was performed. METHODS: Forty consecutive patients were investigated using a 24-hour dietary recall technique every 3 months after surgery for 1 year. Females only were accepted for greater homogeneity of the sample. All received a vitamin and mineral supplement on a daily basis as a postoperative routine. A questionnaire was employed regarding general, nutritional, and gastrointestinal changes as well as consumption of medications. Dietary intake was analyzed after data processing using the Virtual Nutri software package (São Paulo, SP, Brazil). RESULTS: The surgical response was within the expected range, with about 67% excess weight loss at the end of the 1st year, and the same occurred with gastrointestinal symptoms and drug requirements. Daily energy intake on the 4 analyzed occasions was 529.4 ± 47.4, 710.9 ± 47.6, 833.2 ± 72.0, and 866.2 ± 95,1 kcal/day (mean ± SEM); protein intake was increased in the same proportion at 6 and 9 months, but reduced at 12 months. Thus, patients did not meet standard recommendations regarding calories and proteins, even at the end of the 1st year; iron and zinc intake were also inadequate, although deficiencies were probably staved off by the prescribed supplement preparation. CONCLUSIONS: 1) The risk for postoperative undernutrition was evidenced up to 1 year, while spontaneous improvement in food intake was slow and inefficient; 2) Specific protocols should be devised to improve nutrition and health during the postoperative phase until successful dietary adaptation is achieved.