Nutritional Implications of Obesity: Before and After Bariatric Surgery (original) (raw)

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 Management in Bariatric Surgery Patients

International Journal of Environmental Research and Public Health

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on averag...

Bariatric Surgery or Medical Therapy for Obesity

New England Journal of Medicine, 2012

To the Editor: Mingrone et al. and Schauer et al. (April 26 issue) 1,2 report the results of rigorous randomized, controlled trials comparing various types of bariatric surgery with medical therapy for obesity-associated type 2 diabetes. However, we would like to raise the important issue of micronutrient assessment and management in patients undergoing bariatric surgery. The risk of deficiency (of thiamine; vitamins B 6 , B 12 , and D; calcium; iron; or copper, zinc, or both) is increasingly recognized after malabsorptive bariatric surgery, but these deficiencies may be inadequately diagnosed. 3 For example, we recently described the incidence and prevalence of copper deficiency after Roux-en-Y gastric bypass surgery as 18.8% and 9.6%, respectively. 4 Consensus guidelines recommend that patients should be comprehensively monitored for micronutrient deficiencies after bariatric surgery. 5 Unfortunately, the articles by Mingrone et al. and Schauer et al. do not describe such monitoring. Given the high prevalence of preoperative and postoperative deficiencies of specific nutrients, 3 it is important for clinicians to be aware of these potential complications and to appropriately monitor and treat patients for deficiencies of vitamins, minerals, and trace elements after these increasingly common surgical procedures for obesity.

Review article: The nutritional and pharmacological consequences of obesity surgery

Alimentary pharmacology & therapeutics, 2014

Obesity surgery is acknowledged as a highly effective therapy for morbidly obese patients. Beneficial short-term effects on common comorbidities are practically undisputed, but a growing data pool from long-term follow-up reveals increasing evidence of potentially severe nutritional and pharmacological consequences. To assess the prevalence, causes and symptoms of complications after obesity surgery, to elucidate and compare therapy recommendations for macro- and micronutrient deficiencies, and to explore surgically-induced effects on drug absorption and bioavailability, discussing ramifications for long-term therapy and prophylaxis. PubMed, Embase and MEDLINE were searched using terms including, but not limited to, bariatric surgery, gastric bypass, obesity surgery and Roux-en-Y, coupled with secondary search terms, e.g. anaemia, micronutrients, vitamin deficiency, bacterial overgrowth, drug absorption, pharmacokinetics, undernutrition. All studies in English, French or German publ...

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 ...

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.

Abstract Journal Bariatric Surgery

ANZ Journal of Surgery, 2017

Substantial weight loss in the setting of obesity has considerable metabolic benefits. Yet some studies have shown improvements in obesity-related comorbidities with more modest weight loss. By closely monitoring patients, we aimed to determine the effects of weight loss on the metabolic syndrome, and determine the target weight loss required for its resolution. Methodology: We performed a prospective observational study of obese participants with metabolic syndrome (ATPIII) who underwent gastric banding. Participants were assessed for all criteria of the metabolic syndrome each month for nine months, then three-monthly until 24 months. Results: There were 89 participants recruited, with baseline BMI 42.4AE6.2kg and age 48.2AE10.7years. Resolution of the metabolic syndrome occurred in 60 of 89 participants (67%) at 12 months and 60 of 75 participants (80%) at 24 months. The mean weight loss when metabolic syndrome resolved was 10.9AE7.7% total body weight loss (TBWL). Median weight loss at which prevalence of disease was halved was 7.0% TBWL for hypertriglyceridemia; 11% TBWL for HDL cholesterol and hyperglycaemia; 20% TBWL for hypertension; 29% TBWL for waist circumference. Achieving 10-12.5% TBWL correlated with a 2.09 (p=0.025) odds of resolution of the metabolic syndrome with increasing probability of resolution with more substantial weight loss. Conclusion: In obese participants, a weight loss target of 10-12.5% TBWL (25-30% EWL) is a reasonable initial goal for metabolic benefits. Further metabolic improvement could be expected with additional weight loss. These findings can help inform weight loss efforts, in counselling patients, determining targets and assessing success of weight loss strategy.

New look at nutritional care for obese patient candidates for bariatric surgery

Surgery for Obesity and Related Diseases, 2013

Background: The combination of preoperative deficiencies and the restrictions and malabsorption possibly induced by bariatric surgery could lead patients to experience important nutritional deficits during the late postoperative period. Our objective was to characterize the eating, anthropometric, and biochemical profiles of obese candidates for bariatric surgery at a bariatric surgery center of a university hospital. Methods: A retrospective study with the analysis of medical records of candidates for bariatric surgery from 2007 to 2008 was performed. A total of 80 adult patients, aged 45 Ϯ 11 years, were included in the present study. Results: The mean patient weight was 145 Ϯ 24 kg, and the mean body mass index was 54 Ϯ 8 kg/m 2 . Of the 80 patients, 78% had Ն1 co-morbidities related to obesity. The reported daily energy intake before surgery was 1981 Ϯ 882 kcal, with 48% Ϯ 11% consisting of carbohydrate, 29% Ϯ 8% of lipids, and 23% Ϯ 8% of protein. The mean number of daily meals was 4 Ϯ 1. Patients with a greater body mass index ingested a smaller amount of calories per kilogram of current weight. The occurrence of hyperglycemia, hyperuricemia, and dyslipidemia and of nutritional deficiencies, among them magnesium (19%), vitamin A (15%), vitamin C (16%), iron (9%), ␤-carotene (3%), and vitamin B 12 (3%), was high. Conclusion: The high occurrence of micronutrient deficiency detected by biochemical analysis in morbidly obese candidates for bariatric surgery, representing a disabsorptive process, might involve a poorer prognosis during the late postoperative period. A preoperative evaluation of the nutritional parameters and the food intake pattern is recommended for these patients, together with the necessary interventions. (Surg Obes Relat Dis 2013;9:520 -525.)

Nutritional status prior to bariatric surgery for severe obesity: a review

Medicine and Pharmacy Reports

Obesity pandemic represents a threat to public health of paramount importance. Bariatric surgery represents the most effective and long-lasting treatment for severe obesity so far. The nutritional status of obese patients seeking bariatric surgery is impaired prior to surgery because of prevalent nutritional deficiencies. In addition, excess micronutrient levels may also occur, although this finding is not common. The onset of nutritional anomalies encountered in bariatric surgery candidates might stem from the following: obesity itself, poor quality food choices, preoperative weight loss or insufficient/excessive preoperative oral supplementation with vitamins and minerals. Nutritional management should begin preoperatively and should include a comprehensive assessment in order to identify those patients with clinical or subclinical deficiencies and hypervitaminoses. This paper provides background information on the nutritional status of bariatric surgery candidates, as well as on ...