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Clinical Nutrition for Bariatric Surgery

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 22174

Special Issue Editors


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Guest Editor
Bariatric Surgery Unit, Department of Surgery, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy
Interests: bariatric surgery; obesity; nutrition; surgery; sleeve gastrectomy; gastric bypass; metabolic surgery

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Guest Editor
Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy
Interests: bariatric surgery; obesity; nutrition; surgery; sleeve gastrectomy; gastric bypass

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Guest Editor
Department of Systems Medicine, University of Rome Tor Vergata, UOC of Internal Medicine – Obesity Center, Policlinico Tor Vergata, 00133 Rome, Italy
Interests: obesity; adipose tissue; bariatric surgery; type 2 diabetes; NAFLD
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Special Issue Information

Dear Colleagues,

The ongoing obesity epidemic has prompted an exponential rise in performance of bariatric surgical procedures worldwide, and long-term experience has now accumulated, allowing for constantly improving patient outcomes. Nevertheless, some issues persist in the correct management of clinical nutrition for these patients both in the pre- and postoperative phases. In particular, there is no consensus on strategies or diets for preoperative optimization. Postoperatively, malnutrition and vitamin deficiencies remain relevant clinical problems, especially with malabsorptive procedures and poor adherence to nutritional prescriptions being important contributors to suboptimal or adverse outcomes. Furthermore, disorders of eating behavior are still not efficiently tackled and are often responsible for a poor quality of life and ongoing or long-term problems complications such as weight regain.

With this Special Issue on “Clinical Nutrition for Bariatric Surgery”, we would like to advance our knowledge on clinical nutrition in bariatric patients along the whole course of their journey. We encourage the submission of original research and review articles that cover the gaps of knowledge on the importance of nutrition in bariatric patients before and after surgery.

We expect this Special Issue to attract significant interest in view of the worrying worldwide burden of obesity, its complications, and complications of its management.

We look forward to receiving your contributions and will be pleased to answer queries you might have regarding article submission.

Prof. Dr. Paolo Gentileschi
Prof. Dr. Mario Musella
Prof. Dr. Valeria Guglielmi
Guest Editors

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Published Papers (8 papers)

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Research

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11 pages, 293 KiB  
Article
Medium-Term Nutritional and Metabolic Outcome of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
by Giuseppe Marincola, Valeria Velluti, Nikolaos Voloudakis, Pierpaolo Gallucci, Luigi Ciccoritti, Francesco Greco, Luca Sessa, Giulia Salvi, Amerigo Iaconelli, Barbara Aquilanti, Caterina Guidone, Esmeralda Capristo, Geltrude Mingrone, Francesco Pennestrì and Marco Raffaelli
Nutrients 2023, 15(3), 742; https://doi.org/10.3390/nu15030742 - 1 Feb 2023
Cited by 9 | Viewed by 3034
Abstract
Introduction: Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism. Objectives: We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and [...] Read more.
Introduction: Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism. Objectives: We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and metabolic results in patients who underwent SADI-S both as a primary or revisional procedure. Methods: One hundred twenty-one patients were scheduled for SADI-S as a primary or revisional procedure from July 2016 to February 2020 and completed at least 2 years of follow-up. Demographic features, bariatric, nutritional, and metabolic results were analyzed during a stepped follow-up at 3 months, 6 months, 1 year and 2 years. Results: Sixty-six patients (47 female and 19 male) were included. The median preoperative BMI was 53 (48–58) kg/m2. Comorbidities were reported in 48 (72.7%) patients. At 2 years, patients had a median BMI of 27 (27–31) kg/m2 (p < 0.001) with a median %EWL of 85.3% (72.1–96.1), a TWL of 75 (49–100) kg, and a %TWL of 50.9% (40.7–56.9). The complete remission rate was 87.5% for type 2 diabetes mellitus, 83.3% for obstructive sleep apnea syndrome and 64.5% for hypertension. The main nutritional deficiencies post SADI-S were vitamin D (31.82%) and folic acid deficiencies (9.09%). Conclusion: SADI-S could be considered as an efficient and safe procedure with regard to nutritional status, at least in mid-term (2 years) results. It represents a promising bariatric procedure because of the excellent metabolic and bariatric outcomes with acceptable nutritional deficiency rates. Nevertheless, larger studies with longer follow-ups are necessary to draw definitive conclusions. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
11 pages, 676 KiB  
Article
Alterations in Fecal Short-Chain Fatty Acids after Bariatric Surgery: Relationship with Dietary Intake and Weight Loss
by Jennifer L. Meijer, Meredith N. Roderka, Elsa L. Chinburg, Timothy J. Renier, Auden C. McClure, Richard I. Rothstein, Elizabeth L. Barry, Sarah Billmeier and Diane Gilbert-Diamond
Nutrients 2022, 14(20), 4243; https://doi.org/10.3390/nu14204243 - 12 Oct 2022
Cited by 10 | Viewed by 2375
Abstract
Bariatric surgery is associated with weight loss attributed to reduced caloric intake, mechanical changes, and alterations in gut hormones. However, some studies have suggested a heightened incidence of colorectal cancer (CRC) has been associated with bariatric surgery, emphasizing the importance of identifying mechanisms [...] Read more.
Bariatric surgery is associated with weight loss attributed to reduced caloric intake, mechanical changes, and alterations in gut hormones. However, some studies have suggested a heightened incidence of colorectal cancer (CRC) has been associated with bariatric surgery, emphasizing the importance of identifying mechanisms of risk. The objective of this study was to determine if bariatric surgery is associated with decreases in fecal short-chain fatty acids (SCFA), a group of bacterial metabolites of fiber. Fecal samples (n = 22) were collected pre- (~6 weeks) and post-bariatric surgery (~4 months) in patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. SCFA levels were quantified using liquid chromatography/mass spectrometry. Dietary intake was quantified using 24-h dietary recalls. Using an aggregate variable, straight SCFAs significantly decreased by 27% from pre- to post-surgery, specifically acetate, propionate, butyrate, and valerate. Pre-surgery weight was inversely associated with butyrate, with no association remaining post-surgery. Multiple food groups were positively (sugars, milk, and red and orange vegetables) and inversely (animal protein) associated with SCFA levels. Our results suggest a potential mechanism linking dietary intake and SCFA levels with CRC risk post-bariatric surgery with implications for interventions to increase SCFA levels. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
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10 pages, 293 KiB  
Article
Long-Term Results at 10 Years of Pouch Resizing for Roux-en-Y Gastric Bypass Failure
by Céline Drai, Andrea Chierici, Luigi Schiavo, Tagleb S. Mazahreh, Anne-Sophie Schneck and Antonio Iannelli
Nutrients 2022, 14(19), 4035; https://doi.org/10.3390/nu14194035 - 28 Sep 2022
Cited by 2 | Viewed by 1711
Abstract
Background: Roux-en-Y gastric bypass (RYGB) is currently one of the most performed bariatric procedures and it is associated with rapid weight loss. However, weight loss failure and weight regain after RYGB occurs in approximately 30% and 3–5% of patients, respectively, and represent a [...] Read more.
Background: Roux-en-Y gastric bypass (RYGB) is currently one of the most performed bariatric procedures and it is associated with rapid weight loss. However, weight loss failure and weight regain after RYGB occurs in approximately 30% and 3–5% of patients, respectively, and represent a serious issue. RYGB pouch resizing is a surgical option that may be offered to selected patients with RYGB failure. The aim of this study is to assess long-term results of pouch resizing for RYGB failure. Materials and Methods: From February 2009 to November 2011, 20 consecutive patients underwent gastric pouch resizing for RYGB failure in our tertiary bariatric center. The primary outcome was the rate of failure (%EWL < 50% with at least one metabolic comorbidity) after at least 10 years from pouch resizing. Gastroesophageal Reflux Disease (GERD) was also assessed. Results: Twenty patients (18 women (90%)) were included and seventeen (85%) joined the study. The failure rate of pouch resizing was 47%. Mean %EWL and mean BMI were 47%, and 35.1 kg/m2, respectively. Some of the persistent co-morbidities further improved or resolved after pouch resizing. Seven patients (41%) presented GERD requiring daily PPI with a significantly lower GERD-HQRL questionnaire score after pouch resizing (p < 0.001). Conclusion: Pouch resizing after RYGB results in a failure rate of 47% at the 10-year follow-up while the resolution of comorbidities is maintained over time despite a significant weight regain. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
11 pages, 578 KiB  
Article
Nutritional Status after Roux-En-Y (Rygb) and One Anastomosis Gastric Bypass (Oagb) at 6-Month Follow-Up: A Comparative Study
by Paolo Gentileschi, Leandro Siragusa, Federica Alicata, Michela Campanelli, Chiara Bellantone, Tania Musca, Emanuela Bianciardi, Claudio Arcudi, Domenico Benavoli and Bruno Sensi
Nutrients 2022, 14(14), 2823; https://doi.org/10.3390/nu14142823 - 9 Jul 2022
Cited by 10 | Viewed by 2279
Abstract
Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data [...] Read more.
Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data are controversial. The aim of this study is to objectively evaluate and compare malnutrition in patients undergoing RYGB and OAGB. Methods: Retrospective monocentric study of obese patients undergoing RYGB or OAGB between the 15 September 2020 and the 31 May 2021. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and compared between groups. The primary outcome was the mean CONUT score at 6 months. The secondary outcomes included the incidence of malnutrition, comorbidities, including hypertension, insulin resistance and type II diabetes mellitus, and weight loss. Results: 78 patients were included: 30 underwent RYGB and 48 underwent OAGB. At 6-Month Follow-Up there was no difference between groups in the mean CONUT score nor in incidence of malnutrition. In both groups, the nutritional status significantly worsened 6 months after surgery (preoperative and postoperative score of 0.48 ± 0.9 and 1.38 ± 1.5; p = 0.0066 for RYGB and of 0.86 ± 1.5 and 1.45 ± 1.3; p = 0.0422 for OAGB). Type II Diabetes mellitus (DMII) and hypertension remission were significant in the OAGB group with a 100% relative remission in the DMII-OAGB group (p = 0.0265), and a 67% relative remission in the hypertension-OAGB group (p = 0.0031). Conclusions: No difference in nutritional status has been detected between patients undergoing RYGB or OAGB at the 6-Month Follow-Up. Both procedures may have significant mal-absorptive effects leading to decline in nutritional status. OAGB may be more efficacious in inducing DMII and hypertension remission. Larger prospective studies dedicated specifically to nutritional status after gastric bypass are needed to confirm the impact of different bypass procedures on nutritional status. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
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10 pages, 251 KiB  
Article
Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition
by Adam Abu-Abeid, Or Goren, Shai Meron Eldar, Antonio Vitiello, Giovanna Berardi, Guy Lahat and Danit Dayan
Nutrients 2022, 14(11), 2356; https://doi.org/10.3390/nu14112356 - 6 Jun 2022
Cited by 6 | Viewed by 2616
Abstract
Background: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein–energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. Methods: This was a single-center retrospective [...] Read more.
Background: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein–energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. Methods: This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015–2021). Perioperative data and outcomes were retrieved. Results: Ten patients underwent revision for severe PEM. Our center’s incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal (n = 5), BPL shortening (n = 3), and conversion to Roux-en-Y gastric bypass (RYGB) (n = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m2 (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m2 and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening. Conclusions: Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
13 pages, 2660 KiB  
Article
Changes in Food Choice, Taste, Desire, and Enjoyment 1 Year after Sleeve Gastrectomy: A Prospective Study
by Luigi Schiavo, Silvana Mirella Aliberti, Pietro Calabrese, Anna Maria Senatore, Lucia Severino, Gerardo Sarno, Antonio Iannelli and Vincenzo Pilone
Nutrients 2022, 14(10), 2060; https://doi.org/10.3390/nu14102060 - 14 May 2022
Cited by 6 | Viewed by 2717
Abstract
Obesity is a well-recognized global health problem, and bariatric surgery (BS)-induced weight reduction has been demonstrated to improve survival and obesity-related conditions. Sleeve gastrectomy (SG) is actually one of the most performed bariatric procedures. The underlying mechanisms of weight loss and its maintenance [...] Read more.
Obesity is a well-recognized global health problem, and bariatric surgery (BS)-induced weight reduction has been demonstrated to improve survival and obesity-related conditions. Sleeve gastrectomy (SG) is actually one of the most performed bariatric procedures. The underlying mechanisms of weight loss and its maintenance after SG are not yet fully understood. However, changes to the taste function could be a contributing factor. Data on the extent of the phenomenon are limited. The primary objective was to assess, through validated questionnaires, the percentage of patients who report an altered perception of post-SG taste and compare the frequency of intake of the different food classes before SG and after 1 year follow-up. The secondary objective was to evaluate the total body weight change. Materials and Methods: We prospectively investigated the changes in food choice and gustatory sensitivity of 52 patients (55.8% females) 12 months after SG. The mean initial weight and body mass index (BMI) were 130.9 ± 24.7 kg and 47.4 ± 7.1 kg/m2, respectively. The frequency of food intake was assessed by food-frequency questionnaire, while changes in taste perception were assessed using the taste desire and enjoyment change questionnaire. The change in total body weight was also assessed. Results: A significant decrease in the intake frequency of bread and crackers (p < 0.001), dairy products and fats (p < 0.001), sweets and snacks (p < 0.001) and soft drinks (p < 0.001), and a significant increase in the frequency of vegetable and fruit consumption (p < 0.001) were observed at 12 months after SG in both genders. On the contrary, we found no significant changes in the frequency of meat and fish intake in females (p = 0.204), whereas a significant change was found in males (p = 0.028). Changes in perceived taste intensity of fatty foods (p = 0.021) and tart foods (p = 0.006) for females and taste of bitter foods for females and males (p = 0.002; p = 0.017) were found. Regarding the change in food desire for both genders, there was a decrease in the desire for sweet, fatty, and salty foods, whereas there was an increasing trend in the desire for tart foods, especially for females. Significant reduction in total body weight and BMI was observed in both genders at the time of follow-up. Conclusions: Based on our findings, we are able to support the evidence that changes in taste, desire, and enjoyment of taste are very common after SG, with a reduced preference for food with high sugar and fat content and an increased postoperative preference for low-sugar and -fat foods. However, further investigation is needed to clarify this issue. The molecular, hormonal, and central mechanisms underlying these changes in taste perception need to be further elucidated, as they could identify new targets able to modify obesogenic eating behavior, opening up a novel personalized therapeutic approach to obesity. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
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Review

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9 pages, 875 KiB  
Review
Ketogenic Diet for Preoperative Weight Reduction in Bariatric Surgery: A Narrative Review
by Luca Colangeli, Paolo Gentileschi, Paolo Sbraccia and Valeria Guglielmi
Nutrients 2022, 14(17), 3610; https://doi.org/10.3390/nu14173610 - 31 Aug 2022
Cited by 6 | Viewed by 3707
Abstract
Bariatric surgery (BS) is the most effective treatment in reducing weight and the burden of comorbidities in patients with severe obesity. Despite the overall low mortality rate, intra- and post-operative complications remains quite common. Weight loss before BS reduces surgical risk, but studies [...] Read more.
Bariatric surgery (BS) is the most effective treatment in reducing weight and the burden of comorbidities in patients with severe obesity. Despite the overall low mortality rate, intra- and post-operative complications remains quite common. Weight loss before BS reduces surgical risk, but studies are inconclusive regarding which is the best approach to apply. In this review, we summarize the current evidence on the effect of a ketogenic diet (KD) before BS. All studies agree that KD leads to considerable weight loss and important improvements in terms of surgical risk, but populations, interventions and outcomes are very heterogeneous. KD appears to be a safe and effective approach to induce weight loss before BS. However, randomized controlled trials with better-defined dietary protocols and homogeneous outcomes are necessary in order to draw firm conclusions. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
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Other

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8 pages, 251 KiB  
Brief Report
Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery
by Mario Musella, Giovanna Berardi, Antonio Vitiello, Danit Dayan, Vincenzo Schiavone, Antonio Franzese and Adam Abu-Abeid
Nutrients 2022, 14(16), 3319; https://doi.org/10.3390/nu14163319 - 13 Aug 2022
Cited by 8 | Viewed by 2200
Abstract
Background: Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity. Vitamin D deficiency is a common complication encountered both during preoperative workup and follow-up. Aim: To estimate the prevalence of vitamin D deficiency in patients undergoing MBS. Methods: Prospectively maintained [...] Read more.
Background: Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity. Vitamin D deficiency is a common complication encountered both during preoperative workup and follow-up. Aim: To estimate the prevalence of vitamin D deficiency in patients undergoing MBS. Methods: Prospectively maintained database of our university MBS center was searched to assess the rate of preoperative and postoperative vitamin D deficiency or insufficiency in patients undergoing MBS over a one-year period. Results: In total, 184 patients were included, 85 cases of Sleeve Gastrectomy (SG), 99 Gastric Bypass (GB; 91 One Anastomosis and 8 Roux-en-Y). Preoperative vitamin D deficiency and insufficiency were respectively found in 61% and 29% of patients, with no significant difference between SG and GB. After six months, 15% of patients had vitamin D deficiency, and 34% had vitamin D insufficiency. There was no significant difference in the rate of vitamin D deficiency or insufficiency and the percentage of total weight loss (%TWL) at 1, 3, and 6 postoperative months between SG and GB. Conclusions: Preoperative vitamin D deficiency or insufficiency is common in MBS candidates. Regular follow-up with correct supplementation is recommended when undergoing MBS. Early postoperative values of vitamin D were comparable between SG and OAGB. Full article
(This article belongs to the Special Issue Clinical Nutrition for Bariatric Surgery)
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