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Nutrition and Bariatric Surgery

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 October 2017) | Viewed by 45033

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Special Issue Editors

Prof. Dr. Caroline M. Apovian

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Guest Editor

Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
Interests: weight loss and management; adipose tissue; bariatric surgery; inflammation; diabetes; racial disparities

Assoc. Prof. Nawfal Istfan

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Guest Editor

Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
Interests: racial differences in diabetes; weight loss and insulin resistance; clinical outcomes after bariatric surgery; nutrition and cancer; protein metabolism and cell proliferation

Special Issue Information

Dear Colleagues,

The 2013 Obesity Treatment Guidelines, published by American Heart Association/The Obesity Society/the American College of Cardiology (AHA/TOS/ACC), recommended that all providers discuss the option of bariatric surgery in all patients with obesity who meet the appropriate criteria and are otherwise potentially appropriate candidates for the surgery. Between 200,000 and 300,000 people with extreme obesity undergo bariatric surgery each year. Healthcare professionals, counselling bariatric patients, need to become aware of the possible nutritional complications and their symptoms. Because of the increasing number of patients undergoing this surgery each year, more and more patients will present with these macro- and micronutrient complications and, thus, the literature is ripe with case reports and reviews. In addition, racial and ethnic differences in outcomes after bariatric surgery also span nutritional deficiencies. This Special Issue of Nutrients, entitled “Nutrition and Bariatric Surgery”, welcomes the submission of manuscripts describing either original research or systematic reviews and meta-analyses.

Potential topics may include, but are not limited to:

Macronutrient (protein, etc.) and body composition changes after bariatric surgery;
Micronutrient deficiencies after bariatric surgery;
Maternal micronutrient deficiencies and related neonatal outcomes after maternal bariatric surgery;
Trace element deficiencies after bariatric surgery;
Anemia and differences in ethnic and racial groups after bariatric surgery;
Bone mineral density changes after bariatric surgery and relationship to vitamin D;
Nutritional outcomes after bariatric surgery and differences in racial and ethnic groups;
Adolescent bariatric surgery and nutrition deficiencies.

Prof. Caroline M. Apovian
Assoc. Prof. Nawfal Istfan
Guest Editors

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Keywords

Nutritional deficiencies
Bariatric surgery
Obesity and overweight
Roux en Y gastric bypass
Sleeve gastrectomy
Micronutrient deficiencies
Weight loss surgery

Published Papers (6 papers)

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Research

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11 pages, 250 KiB

Open AccessArticle

Nutritional Status of Bariatric Surgery Candidates

by Aliaa Al-Mutawa, Alfred Kojo Anderson, Salman Alsabah and Mohammad Al-Mutawa

Nutrients 2018, 10(1), 67; https://doi.org/10.3390/nu10010067 - 11 Jan 2018

Cited by 35 | Viewed by 6176

Abstract

Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B₁₂ (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B₆ (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

711 KiB

Open AccessArticle

Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity

by Katie Nance, J. Christopher Eagon, Samuel Klein and Marta Yanina Pepino

Nutrients 2018, 10(1), 18; https://doi.org/10.3390/nu10010018 - 24 Dec 2017

Cited by 42 | Viewed by 6524

Abstract

The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB) has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG). We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB (n = 23) or SG (n = 8): (1) sweet, savory, and salty taste sensitivity; (2) the most preferred concentrations of sucrose and monosodium glutamate; (3) sweetness palatability, by using validated sensory testing techniques; and (4) eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1) frequency of cravings for foods; (2) influence of emotions and external food cues on eating behavior; and (3) shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p-values ≤ 0.01). Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

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1304 KiB

Open AccessArticle

Is Trabecular Bone Score Valuable in Bone Microstructure Assessment after Gastric Bypass in Women with Morbid Obesity?

by Agustina Pia Marengo, Fernando Guerrero Pérez, Luis San Martín, Rosa Monseny, Anna Casajoana, Rocio Valera, Nuria Virgili, Andreu Simó Servat, Albert Prats, Carmen Gómez-Vaquero and Nuria Vilarrasa

Nutrients 2017, 9(12), 1314; https://doi.org/10.3390/nu9121314 - 02 Dec 2017

Cited by 17 | Viewed by 4501

Abstract

Introduction: The effects of bariatric surgery on skeletal health raise many concerns. Trabecular bone score (TBS) is obtained through the analysis of lumbar spine dual X-ray absorptiometry (DXA) images and allows an indirect assessment of skeletal microarchitecture (MA). The aim of our study was to evaluate the changes in bone mineral density (BMD) and alterations in bone microarchitecture assessed by TBS in morbidly obese women undergoing Roux-en-Y gastric bypass (RYGB), over a three-year follow-up. Material/Methods: A prospective study of 38 morbidly obese white women, aged 46.3 ± 8.2 years, undergoing RYGB was conducted. Biochemical analyses and DXA scans with TBS evaluation were performed before and at one year and three years after surgery. Results: Patients showed normal calcium and phosphorus plasma concentrations throughout the study. However, 25-hydroxyvitamin D (25(OH)D₃) decreased, and 71% of patients had a vitamin D deficiency at three years. BMD at femoral neck and lumbar spine (LSBMD) significantly decreased 13.53 ± 5.42% and 6.03 ± 6.79%, respectively, during the three-year follow-up; however Z-score values remained above those for women of the same age. TBS was within normal ranges at one and three years (1.431 ± 106 and 1.413 ± 85, respectively), and at the end of the study, 73.7% of patients had normal bone MA. TBS at three years correlated inversely with age (r = −0.41, p = 0.010), body fat (r = −0.465, p = 0.004) and greater body fat deposited in trunk (r = −0.48, p = 0.004), and positively with LSBMD (r = 0.433, p = 0.007), fat mass loss (r = 0.438, p = 0.007) and lean mass loss (r = 0.432, p = 0.008). In the regression analysis, TBS remained associated with body fat (β = −0.625, p = 0.031; R² = 0.47). The fracture risk, calculated by FRAX^® (University of Sheffield, Sheffield, UK), with and without adjustment by TBS, was low. Conclusion: Women undergoing RYGB in the mid-term have a preserved bone MA, assessed by TBS. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

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378 KiB

Open AccessArticle

Relationship between the Nutritional Status of Vitamin A per Trimester of Pregnancy with Maternal Anthropometry and Anemia after Roux-en-Y Gastric Bypass

by Sabrina Cruz, Andréa Matos, Suelem Pereira Da Cruz, Silvia Pereira, Carlos Saboya and Andréa Ramalho

Nutrients 2017, 9(9), 989; https://doi.org/10.3390/nu9090989 - 08 Sep 2017

Cited by 11 | Viewed by 5721

Abstract

The aim of this study was to compare the nutritional status of vitamin A per trimester of pregnancy, as well as to assess its influence on pre-pregnancy BMI, total gestational weight gain (TGWG) and presence of anemia in women who had previously undergone Roux-en-Y gastric bypass (RYGB). An analytical, longitudinal and retrospective study comprising 30 pregnant women who had previously undergone RYGB was undertaken. In all trimesters of pregnancy, the serum concentrations of retinol, β-carotene, stages of vitamin A deficiency (VAD), night blindness (NB), anemia and anthropometric variables were assessed. VAD in pregnancy affected 90% of women, 86.7% developed NB and 82.8% had mild VAD. TGWG above/below the recommended range was related to the low serum concentrations of β-carotene (p = 0.045) in the second trimester and women with TGWG above the recommended range showed 100% of inadequacy of this nutrient in the third trimester. Among the pregnant women with anemia, 90.9% had VAD and 86.4% had NB. This study highlights the importance of monitoring the nutritional status of vitamin A in prenatal care, due to its relationship with TGWG and the high percentage of VAD and NB found since the beginning of pregnancy. It also reaffirms the use of the cut-off <1.05 μmol/L for determining VAD. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

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Review

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446 KiB

Open AccessReview

Nutrition in Pregnancy Following Bariatric Surgery

by Christopher Slater, Lauren Morris, Jodi Ellison and Akheel A. Syed

Nutrients 2017, 9(12), 1338; https://doi.org/10.3390/nu9121338 - 08 Dec 2017

Cited by 30 | Viewed by 9640

Abstract

The widespread use of bariatric surgery for the treatment of morbid obesity has led to a dramatic increase in the numbers of women who become pregnant post-surgery. This can present new challenges, including a higher risk of protein and calorie malnutrition and micronutrient deficiencies in pregnancy due to increased maternal and fetal demand. We undertook a focused, narrative review of the literature and present pragmatic recommendations. It is advisable to delay pregnancy for at least 12 months following bariatric surgery. Comprehensive pre-conception and antenatal care is essential to achieving the best outcomes. Nutrition in pregnancy following bariatric surgery requires specialist monitoring and management. A multidisciplinary approach to care is desirable with close monitoring for deficiencies at each trimester. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

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671 KiB

Open AccessReview

Pancreatic Exocrine Insufficiency after Bariatric Surgery

by Miroslav Vujasinovic, Roberto Valente, Anders Thorell, Wiktor Rutkowski, Stephan L. Haas, Urban Arnelo, Lena Martin and J.-Matthias Löhr

Nutrients 2017, 9(11), 1241; https://doi.org/10.3390/nu9111241 - 13 Nov 2017

Cited by 30 | Viewed by 11659

Abstract

Morbid obesity is a lifelong disease, and all patients require complementary follow-up including nutritional surveillance by a multidisciplinary team after bariatric procedures. Pancreatic exocrine insufficiency (PEI) refers to an insufficient secretion of pancreatic enzymes and/or sodium bicarbonate. PEI is a known multifactorial complication after upper gastrointestinal surgery, and might constitute an important clinical problem due to the large number of bariatric surgical procedures in the world. Symptoms of PEI often overlap with sequelae of gastric bypass, making the diagnosis difficult. Steatorrhea, weight loss, maldigestion and malabsorption are pathognomonic for both clinical conditions. Altered anatomy after bypass surgery can make the diagnostic process even more difficult. Fecal elastase-1 (FE1) is a useful diagnostic test. PEI should be considered in all patients after bariatric surgery with prolonged gastrointestinal complaints that are suggestive of maldigestion and/or malabsorption. Appropriate pancreatic enzyme replacement therapy should be part of the treatment algorithm in patients with confirmed PEI or symptoms suggestive of this complication. Full article

(This article belongs to the Special Issue Nutrition and Bariatric Surgery)

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