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Khalooeifard R, Rahmani J, Ghoreishy SM, Tavakoli A, Najjari K, Talebpour M. Evaluate the Effects of Different Types of Preoperative Restricted Calorie Diets on Weight, Body Mass Index, Operation Time and Hospital Stay in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta Analysis Study. Obes Surg 2024; 34:236-249. [PMID: 38052747 DOI: 10.1007/s11695-023-06973-w] [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: 04/23/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
Previous studies investigated low-calorie diets (LCD), very-low-calorie diets (VLCD), and very-low-calorie ketogenic diets (VLCKD) in relation to weight loss and outcomes for bariatric surgery patients. However, the overall effects of these diets on various outcomes remain unclear. This study aimed to assess the impact of preoperative restricted calorie diets on weight, body mass index (BMI), operation time (OT), and hospital stay (HS) in bariatric surgery patients. Seventeen articles were analyzed, revealing the highest weight loss (-8.62) and BMI reduction (-5.75) with VLCKD. Due to insufficient data, the impact of these diets on OT and HS could not be determined. Further interventional studies are required to determine the ideal preoperative diet that achieves optimal weight loss, patient compliance, tolerance, acceptance, and surgical outcomes.
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Affiliation(s)
- Razieh Khalooeifard
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Aryan Tavakoli
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosrow Najjari
- Advanced Minimally Invasive Surgery Fellowship, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Advanced Minimally Invasive Surgery Fellowship, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
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Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
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Lo HC, Hsu SC. Effectiveness of a preoperative orlistat-based weight management plan and its impact on the results of one-anastomosis gastric bypass: A retrospective study. PLoS One 2023; 18:e0289006. [PMID: 37506080 PMCID: PMC10381073 DOI: 10.1371/journal.pone.0289006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The aim was to first investigate the efficacy of a preoperative weight management program centered on orlistat, which is mechanistically similar to gastrointestinal bypass procedures in that it restricts dietary fat absorption, and then assess its impact on the results of one-anastomosis gastric bypass (OAGB). MATERIALS AND METHODS We retrospectively reviewed the clinical data of consecutive patients aged 20-65 years with a body mass index (BMI) ≥ 42.5 kg/m2 who underwent primary OAGB from 2014 to 2020. Eligible patients who adhered to a 10-14 day orlistat regimen as part of a 4-6-week diet/lifestyle modification plan preceding surgery were stratified into weight reduction (Group 1) and weight gain (Group 2) groups post treatment. The correlation between pre- and postoperative weight loss and perioperative outcomes was assessed. RESULTS Of 62 eligible patients, 55 met the inclusion criteria and complied with treatment; 35 (64%) patients in Group 1 lost a median of 2.0 kg, and Group 2 had a median weight gain of 2.9 kg. Group 1 had a significantly higher initial BMI (48.9 kg/m2 vs. 44.6 kg/m2; p = 0.003), more females (54% vs. 25%) and a shorter operation time than Group 2 (107 min vs. 140 min; p = 0.109). There was no difference in the incidence of 30-day complications. Weight loss did not differ between the groups at 24 months. CONCLUSION Effective weight control through an orlistat-containing regimen benefitted two-thirds of patients who underwent OAGB; however, further weight loss was not observed at 2 years post-surgery.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Bravo-De Ávila P, Díaz-Roesh M, Gutierrez-Acosta K, Romero RJ. Preoperative Quality of Life Predicting Weight Loss After Laparoscopic Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2023. [DOI: 10.1089/bari.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
| | | | | | - Rey Jesús Romero
- Department of Bariatric and Metabolic Surgery, Obesity Health, Boca del Río, México
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Kimura Y, Fujishima Y, Nishizawa H, Saito T, Miyazaki Y, Shirahase K, Tokuzawa C, Nagai N, Fukuda S, Maeda K, Maeda N, Doki Y, Shimomura I. Changes in Eating Behaviors and Their Associations with Weight Loss in Japanese Patients Who Underwent Laparoscopic Sleeve Gastrectomy. Nutrients 2023; 15:nu15020353. [PMID: 36678222 PMCID: PMC9866351 DOI: 10.3390/nu15020353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) has been established to provide long-term weight loss in severe obesity. In this study, we investigated the factors that affect post-operative weight loss, with a particular focus on changes in eating behaviors. METHODS Time-course changes in body weight and eating behaviors were examined in 49 Japanese patients who underwent laparoscopic sleeve gastrectomy from the first visit to 12 months after surgery. Each eating behavior was evaluated via the questionnaire of the Japan Society for the Study of Obesity. RESULTS Pre-operative weight reduction mediated by dietary and lifestyle interventions showed significant positive correlations with weight loss outcomes at 12 months after surgery. We observed significant decreases in scores for most of the eating behaviors 12 months after surgery. However, "emotional eating behavior" scores declined temporarily in the early post-operative period of one month but thereafter returned to the pre-operative level at 12 months. Furthermore, increases in the scores for "emotional eating behavior" and "sense of hunger" from 1 to 12 months post-operatively were significantly associated with poor weight loss. CONCLUSIONS Our results demonstrate the beneficial effects of MBS on obesity-related eating behaviors, as well as highlighting "emotional eating behavior" as requiring particular attention.
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Affiliation(s)
- Yu Kimura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yuya Fujishima
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Correspondence: ; Tel.: +81-(66)-8793732; Fax: +81-(66)-8793739
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Keiko Shirahase
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Chie Tokuzawa
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Naoko Nagai
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Shiro Fukuda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kazuhisa Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Norikazu Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Metabolism and Atherosclerosis, Graduate School of Medicine Osaka University, Osaka 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
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Comparison of a pre-bariatric surgery very low-calorie ketogenic diet and the Mediterranean diet effects on weight loss, metabolic parameters, and liver size reduction. Sci Rep 2022; 12:20686. [PMID: 36450844 PMCID: PMC9712493 DOI: 10.1038/s41598-022-24959-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
This study compared the effects on weight as well as on metabolic parameters and liver size of a very low-calorie ketogenic diet versus a Mediterranean diet in patients with morbid obesity preparing to undergo bariatric surgery. This prospective comparison study evaluated patients 18-65 years of age who enrolled for bariatric surgery. Study duration was limited to an immediate preoperative period of 15 days. The very low-calorie ketogenic diet incorporated 10-12 kcal/kg/day of energy and 1-1.2 g/kg of protein using Kalibra (Societa Dietetica Medica) (VLCKD-SDM). The Mediterranean diet (MD) included 15-20% protein, 45-50% carbohydrate, and 25-35% fat. Changes in body mass index (BMI), liver size, and anthropometric and metabolic measurements were assessed. Between January 2016 and March 2017, of 45 patients enrolled, 30 completed the study (VLCKD-SDM, n = 15; MD, n = 15). Respective median BMI loss after VLCKD-SDM was 2.7 kg/m2 versus MD 1.4 kg/m2 (p < 0.05); median fat percentage reduction was 3.2 units versus 1.7 units (p < 0.05). Median liver size decreased 5.5% in the VLCKD-SDM group versus 1.7% in the MD group (p < 0.05). Median total cholesterol, and LDL levels decreased in both groups (p < 0.05), with greater relative decreases in the VLCKD-SDM group. Short-term preoperative diet-based weight loss in patients with morbid obesity preparing for bariatric surgery was significantly greater following a very low-calorie ketogenic diet versus a Mediterranean diet. The very low-calorie diet also significantly improved anthropometric and metabolic parameters and reduced preoperative liver size above that of the MD.
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Gomez-Rexrode AE, Chhabra KR, Telem DA, Chao GF. Variation in pre-operative insurance requirements for bariatric surgery. Surg Endosc 2022; 36:8358-8363. [PMID: 35513536 DOI: 10.1007/s00464-022-09293-9] [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: 01/11/2022] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients who wish to undergo bariatric surgery, variation in pre-operative insurance requirements may represent inequity across insurance plan types. We conducted a cross-sectional assessment of the variation in pre-operative insurance requirements. METHODS Original insurance policy documents for pre-operative requirements were obtained from bariatric surgery programs across the entire USA and online insurance portals. Insurance programs analyzed include commercial, Medicaid, and Medicare/TriCare plans. Poisson regression adjusting for U.S. Census region was used to evaluate variation in pre-operative requirements. Analyses were done at the insurance plan level. Our primary outcome was number of requirements required by each plan by insurance type. Our secondary outcome was number of months required to participate in medically supervised weight loss (MSWL). RESULTS Among 43 insurance plans reviewed, representing commercial (60.5%), Medicaid (25.6%), and Medicare/TriCare (14.0%) plans, the number of pre-operative requirements ranged from 1 to 8. Adjusted Poisson regression showed significant variation in pre-operative requirements across plan types with Medicaid-insured patients required to fulfill the greatest number (4.1, 95%CI 2.7 to 5.4) compared to 2.7 (95%CI 2.2 to 3.2, P = 0.028) for commercially insured patients and 2.1 (95%CI 1.1 to 3.1, P = 0.047) for Medicare/TriCare-insured patients. Medicaid-insured patients were also required to complete a greater number of months in MSWL (6.6, 95%CI 5.5 to 7.6) compared to commercially (3.8, 95%CI 2.9 to 4.8, P < .001) and Medicare/TriCare-insured patients (1.7, 95%CI 0.3 to 3.0, P = .001). CONCLUSION The greater frequency of pre-operative requirements in Medicaid plans compared to Medicare/TriCare and commercial plans demonstrates inequity across insurance types which may negatively impact access to bariatric surgery. Pre-operative insurance requirements must be reevaluated and standardized using established evidence to ensure all individuals have access to this life-saving intervention.
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Affiliation(s)
| | - Karan R Chhabra
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grace F Chao
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- Veterans Affairs, National Clinician Scholars Program, Ann Arbor, MI, USA.
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.
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Djouani A, Smith A, Choi J, Lall K, Ambekar S. Cardiac surgery in the morbidly obese. J Card Surg 2022; 37:2060-2071. [PMID: 35470870 DOI: 10.1111/jocs.16537] [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: 01/04/2022] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To improve outcomes in this population, interventions carried out in the preoperative, operative, and postoperative periods have shown promise. Despite this, there are no defined best practice national guidelines for perioperative management of obese patients undergoing cardiac surgery. AIM This review is aimed at clinicians and researchers in the field of cardiac surgery and aims to form a basis for the future development of clinical guidelines for the management of obese cardiac surgery patients. METHODS The PubMed database was utilized to identify relevant literature and strategies employed at various stages of the surgical journey were analyzed. CONCLUSIONS Data presented identified the benefits of preoperative respiratory muscle training, off-pump coronary artery bypass grafting where possible, and early extubation. Further randomized controlled trials are required to identify optimal operative and perioperative management strategies before the introduction of such guidance into clinical practice.
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Affiliation(s)
- Adam Djouani
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Alexander Smith
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Jeesoo Choi
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Kulvinder Lall
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Shirish Ambekar
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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Samaan JS, Zhao J, Qian E, Hernandez A, Toubat O, Alicuben ET, Malik Y, Sandhu K, Dobrowolsky A, Samakar K. Preoperative Weight Loss as a Predictor of Bariatric Surgery Postoperative Weight Loss and Complications. J Gastrointest Surg 2022; 26:86-93. [PMID: 34145492 DOI: 10.1007/s11605-021-05055-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association between preoperative weight loss and bariatric surgery outcomes remains unclear. We explored the utility of preoperative weight loss as a predictor of postoperative weight loss success. Additionally, we examined the association of preoperative weight loss with perioperative complication rates. METHODS Retrospective chart review of patients who underwent primary sleeve gastrectomy or primary Roux-en-Y gastric bypass for weight loss at a single institution between January 2003 and November 2017. Additional follow-up was obtained by a postoperative standardized patient questionnaire. Statistical analysis consisted of bivariate and multivariate logistic regression analysis. RESULTS Our study included 427 patients. Majority were female (n = 313, 73.3%) and underwent sleeve gastrectomy (n = 261, 61.1%). Average age was 45.6 years, and average follow-up was 6.3 years. Greater preoperative weight loss was associated with decreased length of stay (1.8 vs 1.3 days) in patients who underwent sleeve gastrectomy. Multivariable regression analysis revealed that preoperative weight loss was not associated with postoperative weight loss. CONCLUSIONS Preoperative weight loss is not predictive of postoperative weight loss success after bariatric surgery. Greater preoperative weight loss was associated with a mild decreased in length of stay but was not associated with a reduction in operative time, overall complication rates, ICU admissions, or intraoperative complications. The inconclusive literature and our findings do not support the medical necessity of weight loss prior to bariatric surgery for the purpose of reducing surgical complications or predicting successful postoperative weight loss success.
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Affiliation(s)
- Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Jasmine Zhao
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Elaine Qian
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Angelica Hernandez
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Omar Toubat
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Evan T Alicuben
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Yousaf Malik
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Adrian Dobrowolsky
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA.
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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Demerdash HM. Weight regain after bariatric surgery: Promoters and potential predictors. World J Meta-Anal 2021; 9:438-454. [DOI: 10.13105/wjma.v9.i5.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
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12
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Development and validation of a scoring system for pre-surgical and early post-surgical prediction of bariatric surgery unsuccess at 2 years. Sci Rep 2021; 11:21067. [PMID: 34702864 PMCID: PMC8548411 DOI: 10.1038/s41598-021-00475-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) is an effective treatment for morbid obesity. However, a simple and easy-to-use tool for the prediction of BS unsuccess is still lacking. Baseline and follow-up data from 300 consecutive patients who underwent BS were retrospectively collected. Supervised regression and machine-learning techniques were used for model development, in which BS unsuccess at 2 years was defined as a percentage of excess-weight-loss (%EWL) < 50%. Model performances were also assessed considering the percentage of total-weight-loss (%TWL) as the reference parameter. Two scoring systems (NAG-score and ENAG-score) were developed. NAG-score, comprising only pre-surgical data, was structured on a 4.5-point-scale (2 points for neck circumference ≥ 44 cm, 1.5 for age ≥ 50 years, and 1 for fasting glucose ≥ 118 mg/dL). ENAG-score, including also early post-operative data, was structured on a 7-point-scale (3 points for %EWL at 6 months ≤ 45%, 1.5 for neck circumference ≥ 44 cm, 1 for age ≥ 50 years, and 1.5 for fasting glucose ≥ 118 mg/dL). A 3-class-clustering was proposed for clinical application. In conclusion, our study proposed two scoring systems for pre-surgical and early post-surgical prediction of 2-year BS weight-loss, which may be useful to guide the pre-operative assessment, the appropriate balance of patients' expectations, and the post-operative care.
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Systematic Review and Meta-Analysis of the Effectiveness of Insurance Requirements for Supervised Weight Loss Prior to Bariatric Surgery. Obes Surg 2021; 31:5396-5408. [PMID: 34570304 DOI: 10.1007/s11695-021-05731-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Many insurance plans impose strict criteria mandating preoperative weight loss attempts to limit patient's access to surgery. Preoperative acute weight loss has been hypothesized to reduce perioperative risk and to identify compliant patients who may have improved long-term weight loss. In this review, the evidence from studies examining clinical and weight loss outcomes both with and without preoperative weight loss are summarized. Although preoperative weight loss may have modest impact on some factors related to perioperative conduct, the evidence does not support these programs' effectiveness at promoting long-term weight loss. Provision of weight loss surgery should not be contingent on completion of insurance-mandated weight loss goals preoperatively, and these programs may, through patient attrition, actually do more harm than good.
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D'Eusebio C, Boschetti S, Rahimi F, Fanni G, De Francesco A, Toppino M, Morino M, Ghigo E, Bo S. What predicts the unsuccess of bariatric surgery? An observational retrospective study. J Endocrinol Invest 2021; 44:1021-1029. [PMID: 32840764 PMCID: PMC8049900 DOI: 10.1007/s40618-020-01398-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/18/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Bariatric surgery (BS) has been recognized as an effective treatment for most patients with morbid obesity, but a variable range of patients failed to achieve a successful weight-loss. Controversial data are available about predictors of unsuccess. We aimed to retrospectively assess whether clinical baseline characteristics of patients submitted to sleeve gastrectomy (SL) or gastric bypass (GBP) were associated with unsuccessful weight-loss after 12 and 24-month follow-up. METHODS Three hundred patients who underwent BS from the 1st January 2016, with at least 24-months follow-up, were enrolled. Patients were divided according to their percentage of excess weight-loss (%EWL) either < 50% or ≥ 50% after 12 and 24-month follow-up. RESULTS None of the patients was lost at follow-up; 56 (18.7%) patients showed a %EWL < 50% at 24 months. Age, neck circumference, obstructive sleep apnea (OSA) were significantly higher, while total cholesterol and %EWL 6-months lower in those with %EWL < 50% at 12-months. Age, neck circumference, male and OSA rates were increased, while %EWL at 6-months lower in patients with %EWL < 50% at 24-months. In a multiple regression model, age (OR = 1.076; 95% CI 1.029-1.125; p = 0.001; OR = 1.066; 1.027-1.107; p < 0.001) and %EWL at 6-months (OR = 0.876; 0.840-0.913; p < 0.001; OR = 0.950; 0.928-0.972; p < 0.001) were associated with %EWL < 50% both at 12- and 24-months, respectively, and neck circumference (OR = 1.142; 1.011-1.289; p = 0.032) with %EWL < 50% at 24-months. CONCLUSION Older age, larger neck circumference, and %EWL at 6-months were significantly associated with BS unsuccess, showing almost 90% of those patients an unsuccessful weight-loss early after surgery. Further larger studies with longer follow-up are needed to confirm these results.
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Affiliation(s)
- C D'Eusebio
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - S Boschetti
- Dietetic Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - F Rahimi
- Dietetic Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - G Fanni
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - A De Francesco
- Dietetic Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - M Toppino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - E Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - S Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.
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15
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Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery. Obes Surg 2021; 30:2099-2107. [PMID: 32077058 DOI: 10.1007/s11695-020-04446-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The effect of preoperative weight loss via very low caloric diet (VLCD) on long-term weight loss post-bariatric surgery (BS) is conflicting. We analysed its impact on weight loss and other outcomes post-BS. METHODS Patients (n = 306) who underwent sleeve gastrectomy or gastric bypass from 2008 to 2018 were studied. VLCD was prescribed for 14 days preoperatively. Patients were followed up for 5 years. Postoperative weight loss was compared in patients with preoperative weight gain or weight loss < 5% (WL < 5%), and weight loss ≥ 5% (WL ≥ 5%). Preoperative WL compared weight before and after VLCD; postoperative WL compared post-VLCD weight and follow-up weight. Total weight loss (TWL) encompassed pre- and postoperative WL. RESULTS WL was < 5% in 87.3% and ≥ 5% in 12.7%. There was no significant difference in complication rate, duration of surgery or length of stay, regardless of surgical type. Patients with WL < 5% lost more weight postoperatively compared with WL ≥ 5% for up to 60 months (%postoperative WL at 1 month: WL < 5% = 13.7%, WL ≥ 5% = 10%, p = <0.001; 60 months: WL < 5% = 30.6%, WL ≥ 5% = 23.9%, p = 0.041). However, when TWL and percentage of excess body mass index loss (%EBMIL) were measured, there was no difference beyond 6 months. A predictive multivariable model for 1-year %EBMIL was formed. Significant variables included pre-VLCD BMI and preoperative WL, and the relationship between the two. CONCLUSION Preoperative WL via VLCD was associated with reduced postoperative WL after BS, with no significant effect on complications, long-term TWL or %EBMIL. This challenges the notion that preoperative WL via VLCD should be mandated for better postoperative outcomes.
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16
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Monfared S, Athanasiadis DI, Furiya A, Butler A, Selzer D, Hilgendorf W, Banerjee A, Stefanidis D. Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes? Obes Surg 2021; 30:889-894. [PMID: 31707572 DOI: 10.1007/s11695-019-04275-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. METHODS Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35-45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. RESULTS A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43-45 vs 45.01-47) were compared. CONCLUSION WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.
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Affiliation(s)
- Sara Monfared
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. .,Rotary Building at Indiana University, 702 Rotary Circle, Suite 022, Indianapolis, IN, 46202, USA.
| | - Alvin Furiya
- Department of Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Annabelle Butler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Benaiges D, Bisbe M, Pedro-Botet J, de Vargas-Machuca A, Ramon JM, Pera M, Villatoro M, Fontané L, Julià H, Climent E, Castañer O, Roux JAFL, Goday A. Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study. J Clin Med 2020; 9:jcm9103193. [PMID: 33019725 PMCID: PMC7600546 DOI: 10.3390/jcm9103193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. Results: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. Conclusions: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained.
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Affiliation(s)
- David Benaiges
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
- Consorci Sanitari de l’Alt Penedès i Garraf, 08720 Vilafranca del Pendès, Spain
- Correspondence: ; Tel.: +34-932483902; Fax: +34-932483254
| | - Maria Bisbe
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
| | - Juan Pedro-Botet
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
| | - Aleix de Vargas-Machuca
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
| | - Jose M. Ramon
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca IMIM-Hospital del Mar, 08003 Barcelona, Spain; (J.M.R.); (M.P.)
| | - Manuel Pera
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca IMIM-Hospital del Mar, 08003 Barcelona, Spain; (J.M.R.); (M.P.)
| | - Montserrat Villatoro
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
| | - Laia Fontané
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
- Consorci Sanitari de l’Alt Penedès i Garraf, 08720 Vilafranca del Pendès, Spain
| | - Helena Julià
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
| | - Elisenda Climent
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
| | - Olga Castañer
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, 28029 Madrid, Spain
| | - Juana A. Flores-Le Roux
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
| | - Alberto Goday
- Departament de Medicina, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain; (M.B.); (J.P.-B.); (A.d.V.-M.); (H.J.); (E.C.); (J.A.F.-L.R.); (A.G.)
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), IMIM-Hospital del Mar, Barcelona, Biomedical Research Park (Parc de Recerca Biomèdica de Barcelona-PRBB), 08003 Barcelona, Spain;
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain; (M.V.); (L.F.)
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, 28029 Madrid, Spain
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Chang PC, Jhou HJ, Chen PH, Huang CK, Chiang HH, Chen KH, Chang TW. Intragastric Botulinum Toxin A Injection Is an Effective Obesity Therapy for Patients with BMI > 40 kg/m 2: a Systematic Review and Meta-analysis. Obes Surg 2020; 30:4081-4090. [PMID: 32734569 DOI: 10.1007/s11695-020-04842-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
We conducted a systematic review and meta-analysis to assess the efficacy of intragastric BTA injection in patients with obesity and morbid obesity. Five RCTs were identified. Intragastric BTA injection was no superior to saline in absolute weight loss or BMI change, but significantly lengthened the gastric emptying time (MD, 15.57; 95% CI, 8.75 to 22.38). In meta-regression analysis, the absolute weight loss was lower in the patients with high baseline BMI. In subgroup analysis, the use of BTA in absolute weight loss was significantly lower among the patients with baseline BMI more than 40 kg/m2 (MD, - 5.31; 95% CI, - 6.17 to - 4.45). The benefit of intragastric BTA injection in reduction of absolute weight was observed in patients with baseline BMI more than 40 kg/m2.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
- Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
- Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Taichung City, Taiwan
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan.
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Sivakumar J, Chong L, Ward S, Sutherland TR, Read M, Hii MW. Body Composition Changes Following a Very-Low-Calorie Pre-Operative Diet in Patients Undergoing Bariatric Surgery. Obes Surg 2020; 30:119-126. [PMID: 31529393 DOI: 10.1007/s11695-019-04174-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fatty liver in obese patients increases the technical difficulty of bariatric surgery. Pre-operative weight loss with a very-low-calorie diet (VLCD) is commonly used to facilitate surgery. Few studies have quantified the systemic effect of rapid pre-operative weight loss on body composition. The objective of this study is to evaluate body composition changes in bariatric surgery patients undergoing a VLCD. METHODS Body composition assessments were performed between August 2017 and January 2019 using dual-energy X-ray absorptiometry immediately before and after a 2-week VLCD at St Vincent's Hospital Melbourne. Data collected prospectively pre- and post-VLCD included total body weight, excess body weight, body mass index (BMI), lean body mass (LBM), fat mass (FM) and bone mineral content (BMC). The pre- and post-operative results were compared. RESULTS Forty-four patients completed both the 2-week VLCD and body composition assessments. Following a 2-week VLCD, patients lost a mean of 4.5 kg (range - 0.3 to 9.5) in a total body weight and 8.8% (range - 0.9 to 17.1) of excess body weight, with a mean reduction in body mass index of 1.6 kg/m2 (range - 0.2 to 3.1). Loss of LBM was 2.8 kg and was significantly greater than loss of FM, 1.7 kg (p < 0.05). BMC changes were insignificant. CONCLUSION A VLCD is an effective tool for pre-operative weight reduction. In this cohort, a large amount of the total weight loss was attributed to a loss of lean body mass. The impact of significant lean body mass loss and its relationship to short- and long-term health outcomes warrants further assessment.
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Affiliation(s)
- Jonathan Sivakumar
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Lynn Chong
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Salena Ward
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Tom R Sutherland
- Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Matthew Read
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michael W Hii
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
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20
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Reiber BMM, Tenhagen M, Barendregt R, Mekel MP, Cense HA, Demirkiran A. Total weight loss after laparoscopic Roux-en-Y gastric bypass is influenced by preoperative weight loss: can we predict the outcome? Surg Obes Relat Dis 2020; 16:1850-1856. [PMID: 32723600 DOI: 10.1016/j.soard.2020.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/29/2020] [Accepted: 05/23/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Preoperative weight loss (WL) is associated with higher postoperative WL at 1- to 2-year follow-up in patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB). OBJECTIVE To evaluate the possible association between preoperative and postoperative WL at 3-year follow-up and identify risk factors for insufficient WL. SETTING A single-center prospective cohort study in the Netherlands. METHODS Patients undergoing primary LRYGB and laparoscopic conversion from band to bypass (redo LRYGB) were instructed to lose weight preoperatively. Follow-up data were collected 1, 2, and 3 years postoperatively. WL was described as percentage total weight loss (%TWL) and percentage excess body mass index (BMI) loss. Patients were divided into 2 groups: group A lost any amount of weight; group B did not lose any weight or gained weight preoperatively. RESULTS Group A consisted of 230 patients (median preoperative %TWL, 4.8%), and group B consisted of 46 patients (median preoperative %TWL, -1.3%). Median BMI at intake was 44.1 kg/m2. Baseline characteristics were similar. The %TWL and BMI for group A and B in the patients who underwent primary LRYGB at 1, 2, and 3 years was 32.2% (BMI, 28.6 kg/m2) versus 23.9% (BMI, 32.2 kg/m2), 31.8% (BMI, 28.9 kg/m2) versus 25.2% (BMI, 31.9 kg/m2), and 33.3% (BMI, 29.7 kg/m2) versus 21.9% (BMI, 34 kg/m2), respectively, all P < .05. In patients who underwent redo LRYGB no clinically significant differences in postoperative BMI were found. CONCLUSIONS Preoperative WL in primary patients who undergo LRYGB can be useful to identify those at risk of inadequate postoperative WL. In patients who undergo redo LRYGB different risk factors should be considered for prediction of inadequate postoperative WL.
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Affiliation(s)
- Beata M M Reiber
- Department of Bariatric Surgery, Red Cross Hospital, Beverwijk, the Netherlands.
| | - Mark Tenhagen
- Department of Bariatric Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Rosalie Barendregt
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Mauk P Mekel
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Huib A Cense
- Department of Bariatric Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Ahmet Demirkiran
- Department of Bariatric Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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21
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Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg 2020; 29:3385-3400. [PMID: 31367987 DOI: 10.1007/s11695-019-04112-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
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Affiliation(s)
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Opposite of the Shariati Hospital, Tehran, 14395-578, Iran.
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22
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Vicente Martin C, Rabago Torre LR, Castillo Herrera LA, Arias Rivero M, Perez Ferrer M, Collado Pacheco D, Martin Rios MD, Barba Martin R, Ramiro Martin J, Vazquez-Echarri J, Herrera Merino N. Preoperative intragastric balloon in morbid obesity is unable to decrease early postoperative morbidity of bariatric surgery (sleeve gastrectomy and gastric bypass): a clinical assay. Surg Endosc 2020; 34:2519-2531. [PMID: 31399943 DOI: 10.1007/s00464-019-07061-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There are few studies that investigate the usefulness of the preoperative intragastric balloon (IGB). This study will evaluate if pre-surgical weight loss with IGB reduces morbidity and mortality after surgery. METHOD Prospective randomised study of patients with morbid obesity treated with gastric bypass or vertical gastrectomy, with two arms: the balloon arm (B-arm), where an IGB was inserted within the 6 months before surgery, and the control arm (C-arm). RESULTS The study included 66 patients: 65.6% women, 69.6% with bypass. Age: 43 years (SD 10.2) B-arm and 42.6 years (SD 9.2) in the C-arm. We found 34.4% therapeutic failures in IGB. The mean body weight loss, %EWL and BMI reduction before surgery was 16.2 kg (SD 9.84) B-arm versus 4.7 (SD 8.70) in the C-arm, 23.6% versus 4.7% (p < 0.001) and 6.04 versus 1 (p < 0.001), respectively. The hospital stay was 7 days (p25-75: 5-8) B-arm and 7 days (p25-75: 5-9) in the C-arm (p = 0.937). Post-surgical morbidity with IGB was 25% versus 29.5% in the C-arm, p = 0.689. The number needed to treat (NNT) to prevent of post-surgical morbidity was 23 patients. The B-arm presented 54.5% moderate-severe post-surgical adverse events (12.5%) versus 82.6% in the C-arm (23.5%), p = 0.111. The cost of placing a balloon was more than 4000 Euros each. CONCLUSIONS The preoperative balloon does not achieve a reduction in the post-surgical morbidity, nor does it reduce the hospital stay or rate of re-operations. The balloon achieves a higher weight loss result when compared to a diet programme, its added cost must also be given due consideration. TRAIL REGISTRY This study has been registered on ClinicalTrials.gov with the Identifier: NCT01998243 (November 28, 2013).
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Affiliation(s)
- Cristina Vicente Martin
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
- Internal Medicine Department, Hospital Rey Juan Carlos, c/Gladiolo sn, 28933, Móstoles, Madrid, Spain
| | - Luis R Rabago Torre
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain.
- Gastroenterology Department, Hospital San Rafael, C/ Serrano 199, 28016, Madrid, Spain.
| | - Luis A Castillo Herrera
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - Marisa Arias Rivero
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - Miguel Perez Ferrer
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - David Collado Pacheco
- Gastroenterology Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - Maria Dolores Martin Rios
- Internal Medicine Department, Hospital Rey Juan Carlos, c/Gladiolo sn, 28933, Móstoles, Madrid, Spain
- Department of Preventive Medicine, Fundación Jiménez Díaz, Madrid, Spain
| | - Raquel Barba Martin
- Internal Medicine Department, Hospital Rey Juan Carlos, c/Gladiolo sn, 28933, Móstoles, Madrid, Spain
| | - Javier Ramiro Martin
- Surgical Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - Jaime Vazquez-Echarri
- Surgical Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
| | - Norberto Herrera Merino
- Surgical Department, Hospital Severo Ochoa, Av. de Orellana, s/n, 28911, Leganés, Madrid, Spain
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23
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Ilhan ZE, DiBaise JK, Dautel SE, Isern NG, Kim YM, Hoyt DW, Schepmoes AA, Brewer HM, Weitz KK, Metz TO, Crowell MD, Kang DW, Rittmann BE, Krajmalnik-Brown R. Temporospatial shifts in the human gut microbiome and metabolome after gastric bypass surgery. NPJ Biofilms Microbiomes 2020; 6:12. [PMID: 32170068 PMCID: PMC7070067 DOI: 10.1038/s41522-020-0122-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/14/2020] [Indexed: 02/08/2023] Open
Abstract
Although the etiology of obesity is not well-understood, genetic, environmental, and microbiome elements are recognized as contributors to this rising pandemic. It is well documented that Roux-en-Y gastric bypass (RYGB) surgery drastically alters the fecal microbiome, but data are sparse on temporal and spatial microbiome and metabolome changes, especially in human populations. We characterized the structure and function (through metabolites) of the microbial communities in the gut lumen and structure of microbial communities on mucosal surfaces in nine morbidly obese individuals before, 6 months, and 12 months after RYGB surgery. Moreover, using a comprehensive multi-omic approach, we compared this longitudinal cohort to a previously studied cross-sectional cohort (n = 24). In addition to the expected weight reduction and improvement in obesity-related comorbidities after RYGB surgery, we observed that the impact of surgery was much greater on fecal communities in comparison to mucosal ones. The changes in the fecal microbiome were linked to increased concentrations of branched-chain fatty acids and an overall decrease in secondary bile acid concentrations. The microbiome and metabolome data sets for this longitudinal cohort strengthen our understanding of the persistent impact of RYGB on the gut microbiome and its metabolism. Our findings highlight the importance of changes in mucosal and fecal microbiomes after RYGB surgery. The spatial modifications in the microbiome after RYGB surgery corresponded to persistent changes in fecal fermentation and bile acid metabolism, both of which are associated with improved metabolic outcomes.
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Affiliation(s)
- Zehra Esra Ilhan
- Biodesign Swette Center for Environmental Biotechnology, Arizona State University, Tempe, AZ, USA.
- Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe, AZ, USA.
| | - John K DiBaise
- Mayo Clinic, Division of Gastroenterology, Scottsdale, AZ, USA
| | - Sydney E Dautel
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Nancy G Isern
- William R. Wiley Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Young-Mo Kim
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - David W Hoyt
- William R. Wiley Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Heather M Brewer
- William R. Wiley Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Karl K Weitz
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Thomas O Metz
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | | | - Dae-Wook Kang
- Biodesign Swette Center for Environmental Biotechnology, Arizona State University, Tempe, AZ, USA
- Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe, AZ, USA
- Department of Civil & Environmental Engineering, The University of Toledo, Toledo, OH, USA
| | - Bruce E Rittmann
- Biodesign Swette Center for Environmental Biotechnology, Arizona State University, Tempe, AZ, USA
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA
| | - Rosa Krajmalnik-Brown
- Biodesign Swette Center for Environmental Biotechnology, Arizona State University, Tempe, AZ, USA.
- Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe, AZ, USA.
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA.
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Guerrero Pérez F, Sánchez-González J, Sánchez I, Jiménez-Murcia S, Granero R, Simó-Servat A, Ruiz A, Virgili N, López-Urdiales R, Montserrat-Gil de Bernabe M, Garrido P, Monseny R, García-Ruiz-de-Gordejuela A, Pujol-Gebelli J, Monasterio C, Salord N, Gearhardt AN, Carlson L, Menchón JM, Vilarrasa N, Fernández-Aranda F. Food addiction and preoperative weight loss achievement in patients seeking bariatric surgery. EUROPEAN EATING DISORDERS REVIEW 2018; 26:645-656. [DOI: 10.1002/erv.2649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn); Instituto de Salud Carlos III; Madrid Spain
- Clinical Sciences Department, School of Medicine and Health Sciences; University of Barcelona; Barcelona Spain
| | - Roser Granero
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn); Instituto de Salud Carlos III; Madrid Spain
- Department of Psychobiology and Methodology; Autonomous University of Barcelona; Barcelona Spain
| | - Andreu Simó-Servat
- Department of Endocrinology; University Hospital of Bellvitge; Barcelona Spain
| | - Ana Ruiz
- Department of Endocrinology; Joan XXIII University Hospital; Tarragona Spain
| | - Nuria Virgili
- Department of Endocrinology; University Hospital of Bellvitge; Barcelona Spain
| | | | | | - Pilar Garrido
- Dietetics and Nutrition Unit; University Hospital of Bellvitge; Barcelona Spain
| | - Rosa Monseny
- Dietetics and Nutrition Unit; University Hospital of Bellvitge; Barcelona Spain
| | - Amador García-Ruiz-de-Gordejuela
- Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Jordi Pujol-Gebelli
- Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Carmen Monasterio
- Pneumology Department; University Hospital of Bellvitge; Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes); Instituto de Salud Carlos III; Madrid Spain
| | - Neus Salord
- Pneumology Department; University Hospital of Bellvitge; Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes); Instituto de Salud Carlos III; Madrid Spain
| | | | - Lily Carlson
- Department of Psychology; University of Michigan; Ann Arbor Michigan
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Clinical Sciences Department, School of Medicine and Health Sciences; University of Barcelona; Barcelona Spain
- CIBER de Salud Mental (CIBERSAM); Instituto de Salud Carlos III; Madrid Spain
| | - Nuria Vilarrasa
- Department of Endocrinology; University Hospital of Bellvitge; Barcelona Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas; Instituto de Salud Carlos III; Madrid Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn); Instituto de Salud Carlos III; Madrid Spain
- Clinical Sciences Department, School of Medicine and Health Sciences; University of Barcelona; Barcelona Spain
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25
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Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, Zaccardi F, Ghanchi A, Khunti K, Davies MJ, Murphy GJ. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br J Surg 2018; 106:181-189. [DOI: 10.1002/bjs.11001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The aim was to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity.
Methods
This was a systematic review and aggregate data meta-analysis of RCTs and cohort studies. PubMed, MEDLINE, Embase and CINAHL Plus databases were searched from inception to February 2018. Eligibility criteria were: studies assessing the effect of weight loss interventions (low-energy diets with or without an exercise component) on clinical outcomes in patients undergoing any surgical procedure. Data on 30-day or all-cause in-hospital mortality were extracted and synthesized in meta-analyses. Postoperative thromboembolic complications, duration of surgery, infection and duration of hospital stay were also assessed.
Results
A total of 6060 patients in four RCTs and 12 cohort studies, all from European and North American centres, were identified. Most were in the field of bariatric surgery and all had some methodological limitations. The pooled effect estimate suggested that preoperative weight loss programmes were effective, leading to significant weight reduction compared with controls: mean difference –7·42 (95 per cent c.i. –10·09 to –4·74) kg (P < 0·001). Preoperative weight loss interventions were not associated with a reduction in perioperative mortality (odds ratio 1·41, 95 per cent c.i. 0·24 to 8·40; I2 = 0 per cent, P = 0·66) but the event rate was low. The weight loss groups had shorter hospital stay (by 27 per cent). No differences were found for morbidity.
Conclusion
This limited preoperative weight loss has advantages but may not alter the postoperative morbidity or mortality risk.
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Affiliation(s)
- M Roman
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A Monaghan
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - G F Serraino
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - D Miller
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - S Pathak
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Lai
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - A Ghanchi
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - G J Murphy
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
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Schlottmann F, Nayyar A, Herbella FAM, Patti MG. Preoperative Evaluation in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:925-929. [PMID: 30004270 DOI: 10.1089/lap.2018.0391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An adequate preoperative workup is critical for the success of bariatric surgery. A key component of the preoperative evaluation involves a comprehensive patient education about surgical outcomes and the postoperative behavioral regimen required. A complete medical evaluation should include the study of the cardiovascular, pulmonary, and gastrointestinal systems as well as a metabolic status assessment. The nutrition professional should be in charge of the nutritional assessment, preoperative weight loss efforts, and diet education regarding postoperative eating behaviors. A psychological evaluation is also needed because psychosocial factors have a significant impact on the long-term outcomes of bariatric surgery, including adherence to recommended postoperative lifestyle regimen, emotional adjustment, and weight loss outcomes. We recommend preoperative abdominal ultrasound to assess for biliary tract pathology, steatosis, fibrosis, and presence of nonalcoholic steatohepatitis. A routine preoperative esophagogastroduodenoscopy is also recommended to evaluate common gastrointestinal disorders associated with obesity. Preoperative weight loss should be strongly encouraged.
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Affiliation(s)
- Francisco Schlottmann
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
- 2 Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Apoorve Nayyar
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Fernando A M Herbella
- 3 Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo , Sao Paulo, Brazil
| | - Marco G Patti
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
- 4 Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
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27
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Fieber JH, Sharoky CE, Wirtalla C, Williams NN, Dempsey DT, Kelz RR. The Malnourished Patient With Obesity: A Unique Paradox in Bariatric Surgery. J Surg Res 2018; 232:456-463. [PMID: 30463757 DOI: 10.1016/j.jss.2018.06.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/10/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypoalbuminemia is a known risk factor for poor outcomes following surgery. Obesity can be associated with modest to severe malnutrition. We evaluated the impact of hypoalbuminemia on surgical outcomes in patients with obesity undergoing elective bariatric surgical procedures. MATERIALS AND METHODS The 2015 metabolic and bariatric surgery accreditation and quality improvement program database was queried. Patients ≥ 18 y with body mass index ≥35 undergoing bariatric surgery were included. Revision procedures were excluded. Patients were classified by albumin level (albumin ≥3.5 g/dL [normal], 3.49-3.0 g/dL [mild], 2.99-2.5 g/dL [moderate], and <2.5 g/dL [severe]). Independent logistic regression models were developed to estimate the adjusted odds of (1) death or serious morbidity (DSM); (2) mild to moderate complications; (3) severe complications; and (4) 30-d readmissions by albumin level. In addition, effect modification by >10% weight loss was examined. RESULTS A total of 106,577 patients were included in the study. Over 6% of patients had hypoalbuminemia. Fifty-five percent of complications were severe as categorized by the Clavien-Dindo classification. Patients with mild hypoalbuminemia had 20% increased odds of DSM (95% confidence interval: 1.1-1.4). There was increasing likelihood of DSM with severe hypoalbuminemia. Patients with mild hypoalbuminemia had 20% increased odds of 30-d readmission (confidence interval: 1.1-1.3). A >10% weight loss modified the effect of moderate to severe hypoalbuminemia on DSM. CONCLUSIONS More than 6% of patients with obesity undergoing bariatric surgery are malnourished. Hypoalbuminemia is an important and modifiable risk factor for postoperative adverse outcomes following bariatric surgery. Preoperative weight loss >10% combined with moderate to severe hypoalbuminemia is synergistic for high rates of DSM and should be addressed before proceeding with bariatric surgery.
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Affiliation(s)
- Jennifer H Fieber
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
| | - Catherine E Sharoky
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Chris Wirtalla
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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29
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Bariatric Surgery Resistance: Using Preoperative Lifestyle Medicine and/or Pharmacology for Metabolic Responsiveness. Obes Surg 2018; 27:3281-3291. [PMID: 29058238 DOI: 10.1007/s11695-017-2966-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is an effective and durable treatment for individuals with obesity and its associated comorbidities. However, not all patients meet weight loss and/or cardiometabolic goals following bariatric surgery, suggesting that some people are bariatric surgery resistant. The reason for this resistance is unclear, but potential factors, such as adiposity-derived inflammation, insulin resistance, hyperglycemia, and aerobic fitness prior to surgery, have been related to blunted surgery responsiveness. Exercise, diet, and/or pharmacology are effective at reducing inflammation and improving insulin action as well as physical function. Herein, we present data that supports the novel hypothesis that intervening prior to surgery can enhance disease resolution in people who are resistant to bariatric surgery.
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30
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Kraus R, Stekhoven DJ, Leupold U, Marti WR. Linear Mixed Effects Analysis Reveals the Significant Impact of Preoperative Diet Success on Postoperative Weight Loss in Gastric Bypass Surgery. Obes Surg 2018; 28:2473-2480. [DOI: 10.1007/s11695-018-3189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hutcheon DA, Hale AL, Ewing JA, Miller M, Couto F, Bour ES, Cobb WS, Scott JD. Short-Term Preoperative Weight Loss and Postoperative Outcomes in Bariatric Surgery. J Am Coll Surg 2018; 226:514-524. [PMID: 29402531 DOI: 10.1016/j.jamcollsurg.2017.12.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preoperative weight loss is often encouraged before undergoing weight loss surgery. Controversy remains as to its effect on postoperative outcomes. The aim of this study was to determine what impact short-term preoperative excess weight loss (EWL) has on postoperative outcomes in patients undergoing primary vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). STUDY DESIGN All patients who underwent SG (n = 167) or RYGB (n = 188) between 2014 and 2016 and who completed our program-recommended low calorie diet (LCD) for 4 weeks immediately preceding surgery were included. These patients (N = 355) were then divided into 2 cohorts and analyzed according to those who achieved ≥8% EWL (n = 224) during the 4-week LCD period and those who did not (n = 131). Primary endpoints included percent excess weight loss (% EWL) at 1, 3, 6, and 12 months postoperatively. RESULTS Patients achieving ≥8% EWL preoperatively experienced a greater % EWL at postoperative month 3 (42.3 ± 13.2% vs 36.1 ± 10.9%, p < 0.001), month 6 (56.0 ± 18.1% vs 47.5 ± 14.1%, p < 0.001), and month 12 (65.1 ± 23.3% vs 55.7 ± 22.2%, p = 0.003). Median operative duration (117 minutes vs 125 minutes; p = 0.061) and mean hospital length of stay (1.8 days vs 2.1 days; p = 0.006) were also less in patients achieving ≥8% EWL. No significant differences in follow-up, readmission, or reoperation rates were seen. Linear regression analysis revealed that patients who achieved ≥8% EWL during the 4-week LCD lost 7.5% more excess weight at postoperative month 12. CONCLUSIONS Based on these data, preoperative weight loss of ≥8% excess weight, while following a 4-week LCD, is associated with a significantly greater rate of postoperative EWL over 1 year, as well as shorter operative duration and hospital length of stay.
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Affiliation(s)
- Deborah A Hutcheon
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC.
| | - Allyson L Hale
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - Joseph A Ewing
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - Megan Miller
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - Francisco Couto
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - Eric S Bour
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - William S Cobb
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
| | - John D Scott
- Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, SC
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Oved I, Vaiman IM, Hod K, Mardy-Tilbor L, Torban Y, Sherf Dagan S. Poor Health Behaviors Prior to Laparoscopic Sleeve Gastrectomy Surgery. Obes Surg 2017; 27:469-475. [PMID: 27613191 DOI: 10.1007/s11695-016-2358-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Identifying eating and lifestyle behaviors prior to bariatric surgery may assist in better selecting and preparing patients and might lead to improved success rate. The current study aimed to assess eating behaviors and lifestyle trends among laparoscopic sleeve gastrectomy (LSG) candidates and to compare those trends between genders. METHODS This descriptive study was conducted in the bariatric clinic at the Haifa Assuta Medical Center. Data was gathered from medical records of LSG candidates that were evaluated before surgery in our institution between 2008 and 2011. The data included demographics, comorbidities, anthropometrics, weight management history, and lifestyle parameters. Eating pattern and eating habits were determined by eating habits questionnaires. RESULTS A total of 266 LSG surgery candidates (71.4 % female) with an average age of 40.7 ± 10.9 years and pre-surgery BMI of 42.4 ± 4.8 kg/m2 were studied. More than half of the patients have family history of obesity and their onset of obesity was before the age of 18 years (54.5 and 57.9 %, respectively). Most of the patients reported on poor eating habits and sedentary lifestyle: 65.1 % do not eat regular meals, 70.3 % skip over breakfast, 61.9 % presented loss of control eating, 45 % frequently consume sweets, and 80.1 % were classified as none active. There were no differences in eating patterns or lifestyle parameters between genders. CONCLUSION High occurrence of unhealthy eating habits and a non-active lifestyle were detected in morbid obese candidates for LSG surgery. More efforts should be directed towards nutritional and lifestyle education prior to the surgery.
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Affiliation(s)
- Irit Oved
- Department of Nutrition, Assuta Medical Center, Haifa, Israel
| | | | - Keren Hod
- Research Division, Epidemiological Service, Assuta Medical Center, Tel Aviv, Israel
| | | | - Yakov Torban
- Department of Anesthesia, Assuta Medical Center, Haifa, Israel
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Sun BJ, Valdez D, Duong D, Gupta R, Smith BR. Evaluation of Preoperative Weight Loss for Elective Hernia Repair in the Veteran Population. Am Surg 2017. [DOI: 10.1177/000313481708301020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The safety and efficacy of preoperative weight loss before elective nonbariatric surgery is controversial. We evaluated the effect of planned surgical delay for a preoperative weight loss trial in hernia repairs. Four hundred and fourteen patients undergoing elective hernia repair between July 2008 and May 2012 at a Level 1B VA Medical Center were identified. Included patients were divided into two groups: those who underwent immediate hernia repair (nontrial) and those who underwent weight loss trial before hernia repair (TRIAL). Twenty-two patients were categorized in the TRIAL group, and 392 in nontrial. Time from surgical evaluation to operation was longer in the TRIAL vs nontrial group (226 days vs 113 days, P = 0.001). Outcome measures were similar between groups. Net change in body mass index (BMI) was -2.2 per cent in TRIAL vs -0.86 per cent in nontrial patients (P = 0.440). Of the TRIAL patients, ten obtained a poor result (<3% decreased BMI), nine a moderate result (3–10% decreased BMI), and three a good result (>10% decreased BMI). Weight loss trials in elective hernia patients appear to be safe, although they result in significant delay to surgery and confer no difference in postoperative outcomes. Thus, efficacy of preoperative weight loss trials may be limited.
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Affiliation(s)
- Beatrice J. Sun
- Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California
| | - David Valdez
- Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California
| | - Dao Duong
- Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California
| | - Ryan Gupta
- Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California
| | - Brian R. Smith
- Department of Surgery, Veteran Affairs Long Beach Healthcare System, Long Beach, California
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Kim JJ. Evidence Base for Optimal Preoperative Preparation for Bariatric Surgery: Does Mandatory Weight Loss Make a Difference? Curr Obes Rep 2017; 6:238-245. [PMID: 28755179 DOI: 10.1007/s13679-017-0269-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Preoperative weight loss regimens prior to bariatric surgery have been a routine and common practice for many centers, in the US and around the world. The mandated participation in such programs has largely been influenced by loco-regional payer requirements. The relationship between adherence to a mandatory weight loss regimen and achieved preoperative weight loss as well as the clinical impact of preoperative weight loss on bariatric outcomes remains uncertain. RECENT FINDINGS This review examines the available current literature, in the context of previous findings, regarding the impact of mandated preoperative weight loss regimens and mandatory weight loss on bariatric outcomes. The reviewed studies do not provide sufficient evidence that mandatory participation in a preoperative weight loss regimen prior to bariatric surgery is associated with achieved weight loss or durable bariatric outcome benefit. Preoperative weight loss, when achieved, may confer a positive benefit on postoperative complications; however, this is not a consistent finding in the literature and requires further validation. The practice of mandating participation in a preoperative weight loss regimen or requiring mandatory weight loss prior to bariatric surgery is not supported by current literature and may serve as an obstacle to medically necessary and potentially life-saving treatment.
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Affiliation(s)
- Julie J Kim
- Harvard Medical School, Boston, MA, USA.
- Department of Surgery, Weight Management Center, Mount Auburn Hospital, 330 Mount Auburn St, Cambridge, MA, 02138, USA.
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Watanabe A, Seki Y, Haruta H, Kikkawa E, Kasama K. Preoperative Weight Loss and Operative Outcome After Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:2515-2521. [PMID: 28478582 DOI: 10.1007/s11695-017-2697-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr 2017; 8:382-394. [PMID: 28298280 PMCID: PMC5347111 DOI: 10.3945/an.116.014258] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
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Affiliation(s)
- Shiri Sherf Dagan
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, and
| | - Ariela Goldenshluger
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Globus
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Chaya Schweiger
- The Israel Dietetic Association, Herzliya, Israel
- Herzliya Medical Center, Herzliya, Israel
- Nutrition Service, Rabin Medical Center, Petach Tiqva, Israel; and
| | - Yafit Kessler
- The Israel Dietetic Association, Herzliya, Israel
- The Israeli Center for Bariatric Surgery of Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Galit Kowen Sandbank
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel;
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
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CHAIM EA, PAREJA JC, GESTIC MA, UTRINI MP, CAZZO E. Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:70-74. [PMID: 28079244 DOI: 10.1590/s0004-2803.2017v54n1-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.
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Laparoscopic Sleeve Gastrectomy: Preoperative Weight Loss and Other Factors as Predictors of Postoperative Success. Obes Surg 2017; 27:1508-1513. [DOI: 10.1007/s11695-016-2520-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Binda A, Jaworski P, Kudlicka E, Ciesielski A, Cabaj H, Tarnowski W. The impact of selected factors on parameters of weight loss after sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2016; 11:288-294. [PMID: 28194250 PMCID: PMC5299089 DOI: 10.5114/wiitm.2016.64999] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The effectiveness of sleeve gastrectomy has been confirmed in many studies. The impact of individual factors on the parameters of weight loss is still not clear. AIM To identify important factors affecting the parameters of weight loss after sleeve gastrectomy. MATERIAL AND METHODS The impact of prognostic factors and postoperative care components on body mass index (BMI) and percentage excess weight loss (%EWL) was assessed in a group of 100 consecutive patients who underwent laparoscopic sleeve gastrectomy. RESULTS The baseline BMI and body mass in patients with BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 12 months after surgery were, respectively, 39.7 ±3.2 vs. 45.9 ±4.6 kg/m2, p < 0.0001, and 114.4 ±16.8 vs. 130.3 ±18.5 kg, p < 0.0001. In the group with EWL < 50%, the average age was 47.1 ±7.7 vs. 40.6 ±10.8 in the group with EWL ≥ 50%, p = 0.0025. In the group of patients with preoperative weight loss, %EWL was 61.4 ±17.2 vs. 53.3 ±19.3% in the group with no weight loss, p = 0.0496. Body mass index of the patients who started physical activities was 30.6 ±4.2 kg/m2 vs. 34.0 ±5.6 kg/m2 in the patients with no physical activity, p = 0.0013, and %EWL was 63.4 ±14.6 vs. 47.0 ±19.9%, p < 0.0001, respectively. In the case of patients regularly consulted by a dietician BMI was 30.6 ±4.2 kg/m2 vs. 35.1 ±5.5 kg/m2 in the group without systematic consultations, p < 0.0001, and %EWL was 63.1 ±15.1% vs. 42.3 ±18.2%, p < 0.0001. CONCLUSIONS Lower baseline body weight parameters, younger age, preoperative weight loss, starting systematic physical activities and constant care of a dietician were conducive to achieving better results of surgery, as assessed on the basis of changes in BMI and %EWL.
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Affiliation(s)
- Artur Binda
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Paweł Jaworski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Emilia Kudlicka
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Adam Ciesielski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Hubert Cabaj
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
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González HM, Guerrero ES, Vértiz LG, Cabello IO, Rocha GG, Licona GC, Galván MA, López CZ. A Prospective Study of the Clinical, Anthropometrical, and Biochemical Improvement Following a Mandatory Weight Loss of >10% Before Bariatric Surgery. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Gladys Güitrón Rocha
- Department of Bariatric Surgery, Hospital General de Tláhuac, Mexico City, Mexico
| | | | - Mónica Amado Galván
- Department of Bariatric Surgery, Hospital General de Tláhuac, Mexico City, Mexico
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Does Weight Gain During the Operation Wait Time Have an Impact on Weight Loss After Laparoscopic Sleeve Gastrectomy? Obes Surg 2016; 27:338-342. [PMID: 27568031 DOI: 10.1007/s11695-016-2342-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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42
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Liu RH. Do Behavioral Interventions Delivered Before Bariatric Surgery Impact Weight Loss in Adults? A Systematic Scoping Review. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Rebecca H. Liu
- Department of Health & Rehabilitation Sciences, Western University, London, Ontario
- Faculty of Health Sciences, Health Promotion Research Laboratory, Western University, London, Ontario
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Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery. J Nutr Sci 2016; 5:e22. [PMID: 27293559 PMCID: PMC4891557 DOI: 10.1017/jns.2016.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 01/14/2023] Open
Abstract
A preoperative weight loss of 8 % is a prerequisite to undergo bariatric surgery (BS) in Denmark. The aim of the present study was to evaluate the efficacy of a 7- or an 11-week low-energy diet (LCD) for achieving preoperative target weight before BS. A total of thirty obese patients (BMI 46·0 (sd 4·4) kg/m(2)) followed an LCD (Cambridge Weight Plan(®), 4184 kJ/d (1000 kcal/d)) for 7 or 11 weeks as preparation for BS. Anthropometric measurements including body composition (dual-energy X-ray absorptiometry), blood parameters and blood pressure were assessed at weeks 0, 7 and 11. At week 7, the majority of patients (77 %) had reached their target weight, and this was achieved after 5·4 (sem 0·3) weeks. Mean weight loss was 9·3 (sem 0·5) % (P < 0·01) and consisted of 41·6 % fat-free mass (FFM) and 58·4 % fat mass. The weight loss was accompanied by a decrease in systolic and diastolic blood pressure (7·1 (sem 2·3) and 7·3 (sem 1·8) mmHg, respectively, all P < 0·01) as well as an improved metabolic profile (8·2 (sem 1·8) % decrease in fasting glucose (P < 0·01), 28·6 (sem 6·4) % decrease in fasting insulin (P < 0·01), 23·1 (sem 2·2) % decrease in LDL (P < 0·01), and 9·7 (sem 4·7) % decrease in TAG (P < 0·05)). Weight, FFM and fat mass continued to decrease from week 7 to 11 (all P < 0·01), whereas no additional improvements was observed in the metabolic parameters. Severely obese patients can safely achieve preoperative target weight on an LCD within 7 weeks as part of preparation for BS. However, the considerable reduction in FFM in severely obese subjects needs further investigation.
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Conaty EA, Bonamici NJ, Gitelis ME, Johnson BJ, DeAsis F, Carbray JM, Lapin B, Joehl R, Denham W, Linn JG, Haggerty SP, Ujiki MB. Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery. J Gastrointest Surg 2016; 20:667-73. [PMID: 26864165 DOI: 10.1007/s11605-016-3093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/24/2016] [Indexed: 01/31/2023]
Abstract
The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10% excess body weight loss before surgery, by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen. We analyzed our database of 757 patients who underwent primary bariatric surgery between March 2008 and January 2015. Patients were placed into two cohorts based on their participation in a MPWL program requiring at least 10% excess weight loss (EWL) prior to surgery. Patients were evaluated at 3, 6, 12, and 24 months after surgery for weight loss, comorbidity resolution, and the occurrences of hospital readmissions. A total of 717 patients met the inclusion criteria of whom 465 underwent surgery without a preoperative weight loss requirement and 252 participated in the MPWL program. One year after surgery, 67.1% of non-participants and 62.5% of MPWL participants showed a resolution of at least one of five associated comorbidities (p = 0.45). Non-participants showed an average of 58.6% EWL, while MPWL participants showed 59.1% EWL at 1 year postoperatively (p = 0.84). Readmission rates, excluding those which were ulcer-related, at 30 days (3.4 vs. 6.40%, p = 0.11) and 90 days (9.9 vs. 7.5%, p = 0.29) postoperatively were not significantly different between the non-participants and MPWL patients, respectively. A mandatory preoperative weight loss program prior to bariatric surgery did not result in significantly greater %EWL or comorbidity resolution 1 year after surgery compared to patients not required to lose weight preoperatively. Additionally, the program did not result in significantly lower 30- or 90-day readmission rates for these patients. The value of a MPWL program must be weighed against the potential loss of bariatric surgery candidates. Patients who fail to lose 10% excess weight preoperatively are thus ineligible for a procedure from which they would otherwise benefit. Our data suggest these patients will have similar positive outcomes.
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Affiliation(s)
- Eliza A Conaty
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Nicolas J Bonamici
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Matthew E Gitelis
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Brandon J Johnson
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Francis DeAsis
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - JoAnn M Carbray
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Brittany Lapin
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Raymond Joehl
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Woody Denham
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John G Linn
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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Mahawar KK, Parmar C, Carr WRJ, Jennings N, Schroeder N, Balupuri S, Small PK. Preoperative Interventions for Patients Being Considered for Bariatric Surgery: Separating the Fact from Fiction. Obes Surg 2016; 25:1527-33. [PMID: 25994780 DOI: 10.1007/s11695-015-1738-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Preoperative interventions aimed at patients referred for bariatric surgery continue to divide funders, commissioners, and practitioners alike. A number of preoperative interventions and variables have been used to influence patient selection. Many of these are believed to lead to better postoperative outcomes by helping target a limited resource (bariatric surgery) at those most likely to benefit. Inevitably, this leads to competition amongst patients and some being denied benefits of surgery. There is a risk that these strategies for resource allocation may actually deprive the most vulnerable and those most in need. This review examines evidence and justification behind popular preoperative interventions for patients being considered for bariatric surgery patients in the light of published English language scientific literature.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK,
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Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian Obesity Registry (SOReg). Surg Obes Relat Dis 2015; 12:556-562. [PMID: 26922166 DOI: 10.1016/j.soard.2015.08.519] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/03/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Weight loss before bariatric surgery has been found to be associated with reduced rates of postoperative complications. OBJECTIVE To evaluate whether preoperative weight loss was also associated with improved postoperative weight loss over time and if this was dependent on preoperative body mass index (BMI). SETTING Data from the Swedish national registry for bariatric surgery. METHODS Out of 20,564 patients undergoing primary gastric bypass from January 1, 2008 to November 30, 2011, 9570 with complete data on preoperative weight loss and 2 years postoperative weight loss were analyzed. RESULTS Total preoperative weight loss in the 25th, 50th, and 75th percentiles was 0%, 4.5%, and 8.6%, respectively. When comparing patients in the 50th percentile for preoperative weight loss with those in the 25th percentile, total postoperative weight loss was 5.0% and 5.3% higher at 1 and 2 years, respectively (P<.001). Corresponding values for patients in the 75th percentile for preoperative weight loss were 11.8% and 10.1% (P< .001). For patients in the 75th percentile of preoperative BMI (>45.7 kg/m(2)) the effect was even more pronounced. Thus, in this group of patients and within the 75th percentile for preoperative weight loss, the total weight reduction after 1 and 2 years was 15.2% and 13.6% higher compared with patients in the 25th percentile for preoperative weight loss. CONCLUSION In this Swedish national bariatric registry data set, weight loss before gastric bypass was associated with sustained improved postoperative weight reduction. Moreover, there was a relationship between the degree of pre- and postoperative weight loss and the relationship was stronger in patients with high BMI.
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Sherman WE, Lane AE, Mangieri CW, Choi YU, Faler BJ. Does Preoperative Weight Change Predict Postoperative Weight Loss After Laparoscopic Sleeve Gastrectomy? Bariatr Surg Pract Patient Care 2015; 10:126-129. [PMID: 26421248 DOI: 10.1089/bari.2015.0023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Some institutions and insurance companies mandate a preoperative weight loss regimen prior to bariatric surgery. Previous studies suggest little to no correlation between preoperative and postoperative weight loss for laparoscopic Roux-en-Y gastric bypass (RNYGB). This study examined the impact of preoperative weight change for patients undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A retrospective analysis was performed on patients undergoing LSG at the authors' institution from 2010 to 2012. Patients were grouped based on preoperative weight gain or loss. The correlation between preoperative BMI change and postoperative BMI change was studied, as well as length of surgery. Results: Of 141 patients with 1-year follow-up, 72 lost, six maintained, and 64 gained weight preoperatively. Percentage of excess BMI loss at 1 year was not statistically different between those who lost weight and those who gained weight. Percent change in BMI from initial visit to surgery does not correlate with change in BMI at 1 year postoperatively or with length of surgery. Conclusions: Preoperative weight loss is not a reliable predictor of postoperative weight loss or shorter operative time after LSG. Potential patients who otherwise meet indications for LSG should not be denied based on inability to lose weight.
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Affiliation(s)
| | - Aaron E Lane
- William Beaumont Army Medical Center , El Paso, Texas
| | | | - Yong U Choi
- Dwight David Eisenhower Army Medical Center , Fort Gordon, Georgia
| | - Byron J Faler
- Dwight David Eisenhower Army Medical Center , Fort Gordon, Georgia
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Efecto de los patrones de conducta alimentaria y de la pérdida de peso preoperatoria sobre los resultados a corto y medio plazo en pérdida de peso tras gastrectomía vertical laparoscópica. Cir Esp 2015; 93:241-7. [DOI: 10.1016/j.ciresp.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/29/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
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50
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Effect of Preoperative Eating Patterns and Preoperative Weight Loss on the Short- and Mid-term Weight Loss Results of Sleeve Gastrectomy. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cireng.2014.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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