New Insights on the Association Between Socioeconomic Status and Weight Loss After Bariatric Surgery: a Systematic Review and Meta-analysis.

The effect of socioeconomic status (SES) on weight loss (WL) after bariatric surgery (BS) remains unclear. This systematic review and meta-analysis aimed to investigate the association between SES and WL at least 12 months after BS. This study included 53 observational studies (retrieved from databases in October 2021 and updated in February 2022) involving adults who underwent any type of BS; SES data and data regarding outcomes of weight loss were also retrieved. Our results revealed that white individuals had a higher percentage of excess WL than blacks (95% confidence interval [CI]: 3.25-10.99, heterogeneity index [I2] = 44.87% and 95% CI: 8.08-13.59, I2 = 0%, respectively; both p < 0.01) after 12 and 24 months of BS. In conclusion, only race/ethnicity was associated with WL after BS.

Sarcopenic obesity diagnosis by different criteria mid-to long-term post-bariatric surgery.

BACKGROUND/AIMS: The aim of this study was to apply the European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (ESPEN/EASO) consensus to identify sarcopenic obesity (SO) in adults mid to long-term post-Roux-en-Y gastric bypass (RYGB) using both dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Further, this approach was compared to accepted sarcopenia diagnostic criteria (Revised European Working Group on Sarcopenia in Older People [EWGSOP2] and Sarcopenia Definition and Outcomes Consortium [SDOC]). METHODS: This cross-sectional study included adults ≥2 years post-RYGB surgery. Obesity was diagnosed by excess fat mass (FM) for all diagnostic criteria. Agreement was evaluated using Cohen's Kappa. RESULTS: We evaluated 186 participants (90.9% female, median age 43.9 years, 6.8 years post-surgery), of which 60.2% (BIA), and 83.3% (DXA) had excess FM. Low muscle strength was not identified using absolute handgrip strength. The prevalence of SO by BIA or DXA, respectively, was 7.9% (95%CI 3.9-12.5), and 23.0% (95%CI 17.1-30.3) [ESPEN/EASO SO consensus]; 0.7% (95%CI 0-2.0), and 3.3% (95%CI 0.7-5.9) [EWGSOP2]; and 27.0% (95%CI 19.7-34.2), and 30.3% (95%CI 23.0-37.5) [SDOC]. Agreement between the ESPEN/EASO SO consensus and other diagnostic criteria was none to slight using DXA: EWGSOP2 k = 0.19; 95% CI 0.04-0.34, or SDOC k = 0.16; 95% CI -0.01-0.32. Moderate agreement was observed within the ESPEN/EASO SO consensus for BIA and DXA (k = 0.43; 95% CI 0.26-0.60). CONCLUSIONS: This is the first study to explore the prevalence of SO using the ESPEN/EASO criteria. We identified a high but variable prevalence of SO in post-bariatric surgery patients (7.9-23.0%), depending on the body composition technique used; prevalence was higher using DXA. Little agreement was observed for the diagnosis of SO using the three diagnostic criteria. Future studies are needed to explore the relationship between SO identified by the ESPEN/EASO consensus and health status/outcomes.

Grazing Behavior Hinders Weight Loss in Long-Term Post Bariatric Surgery: a Cross-Sectional Study.

BACKGROUND: Grazing behavior is common in patients undergoing bariatric surgery (BS); however, little is known about grazing behavior in operated patients in the long term. We aimed to estimate grazing frequency and its association with weight loss and surgery response in patients who had undergone BS. METHODS: This cross-sectional study included 109 patients who had undergone Roux-en-Y gastric bypass at least 5 years previously. They answered questions about socioeconomic factors, surgical information, and adherence to treatment/follow-up. The Rep(eat) questionnaire was used for grazing assessment. Student's t-test and Pearson's chi-square test were used to evaluate differences between groups. Analysis of covariance and partial correlation were used to investigate grazing behavior, and weight loss outcomes were controlled for the elapsed time since BS, healthcare service type, current psychologist care status, and the presence of a constriction ring. RESULTS: The mean elapsed time since BS was 9.97 ± 2.39 years. Patients with grazing behavior (67%) comprised fewer surgery responders (p = 0.019), had lower total (%TWL, p = 0.005) and excess weight loss (%EWL, p = 0.029), and received less psychological counseling (45.5% vs. 54.5%, p = 0.042). Correlations were found between the presence of grazing and its subtypes and %EWL and %TWL (T = - 0.382, T = - 0.361, p < 0.001; compulsive grazing: T = - 0.358, T = - 0.342, p < 0.001, p = 0.001; non-compulsive grazing: T = - 0.333, T = - 0.311, p = 0.001, p = 0.003). No significant difference between patients with and without grazing behavior was found for previous/current diagnoses of psychological diseases or dietitian counseling. CONCLUSION: Grazing behavior is common in the long-term among patients who have undergone BS and is negatively related to weight loss parameters.

Relative Energy Expenditure Decreases during the First Year after Bariatric Surgery: A Systematic Review and Meta-Analysis.

The effect of bariatric surgery on resting energy expenditure (REE) remains unclear, particularly in terms of the REE/fat-free mass (FFM) ratio. We performed a systematic review with a meta-analysis on Roux-en-Y gastric bypass (RYGB) studies to investigate the effect of bariatric surgery on the REE/FFM ratio 6 and 12 months postoperatively. Five of the 13 records of 6-month data (n = 406) showed a reduction in the REE/FFM ratio without significant summary effects. As regards 12-month data (10 records, n = 713), there was a significant relative REE mean reduction of 1.95 kcal/kg in FFM (CI: -2.82 to -1.09; I2 = 28%; p < 0.00001). These findings suggest that bariatric surgery, specifically RYGB, leads to a decrease in the REE/FFM ratio during the first postoperative year, which may compromise long-term treatment outcomes.

Diet micronutrient adequacy of women after 1 year of gastric bypass.

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamin B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies.

Preoperative nutritional interventions in morbid obesity: impact on body weight, energy intake, and eating quality.

BACKGROUND: Although the benefits of preoperative weight loss and adequacy of dietary patterns in bariatric surgery is well-recognized, the nutritional strategies in the preoperative period have been scarcely investigated. We aimed to evaluate the impact of intensive and standard nutritional interventions on body weight, energy intake, and eating quality. METHODS: This is a retrospective study in which 32 patients undergoing intensive nutritional intervention, with low-calorie diet (10 kcal/kg) and biweekly visits, were pair-matched by age, sex, and body mass index with 32 patients under a standard nutritional intervention, based on a general dietary counseling. Twenty-four-hour food recall was used to assess energy intake and to derive healthy eating index (HEI). The follow-up preoperative period varied from 8 to 16 weeks. RESULTS: Weight loss was observed in 72% of the patients from the intensive intervention group and 75% of the patients from the standard intervention group. According to the mixed model analysis, time effect on weight loss in both groups was significant (P = 0.0002); however, no difference was found between the intervention groups (P = 0.71). The time effect was significant in both groups for energy intake reduction as well (P < 0.0001), but no difference was found between the intervention groups (P = 0.25). Improvement of eating quality was expressed by the nutrient score of the HEI that increased significantly overtime (P = 0.02), also without distinction between the groups (P = 0.61). CONCLUSION: Both intensive and standard nutritional interventions promoted weight loss, energy intake reduction, and improvement of eating quality in morbidly obese patients during preoperative period.

Diet micronutrient adequacy of women after 1 year of gastric bypass / Adequação de micronutrientes da dieta de mulheres após um ano de bypass gástrico

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. .

RACIONAL: O tratamento considerado mais eficiente para o grau severo da obesidade é a cirurgia bariátrica. O bypass gástrico é a técnica cirúrgica mais utilizada no mundo; porém, assim como as outras técnicas, oferece riscos no pós-operatório, incluindo a deficiência de nutrientes. OBJETIVO: Determinar as quantidades de ferro, cálcio, vitamina D e vitamina B12 dietéticas ingeridas por pacientes atendidos em um hospital público após um ano de bypass gástrico, e comparar com as recomendações da Recommended Dietary Allowances. MÉTODOS: Estudo transversal descritivo com amostra composta por 36 mulheres com mais de um ano de bypass gástrico. Foram coletados dados sociodemográficos, antropométricos e alimentares. Estes últimos foram realizados por meio de Questionário de Frequência Alimentar validado. Foi feita comparação da ingestão de ferro, cálcio, vitamina D e vitamina B12 com as Recommended Dietary Allowances, assim como a correlação do tempo de pós-operatório com o consumo desses micronutrientes. RESULTADOS: Houve inadequação no consumo de ferro, cálcio e vitamina D. A ingestão de vitamina B12 mostrou-se adequada. Foi encontrada correlação positiva estatisticamente significativa entre o tempo de operação e o consumo de ferro, vitamina B12 e vitamina D. CONCLUSÃO: A ingestão de ferro, cálcio e vitamina D de mulheres um ano após o bypass gástrico foi inadequada, enfatizando a importância do acompanhamento multiprofissional no pós-operatório para prevenção de carências de nutrientes. .

Determinantes de sucesso após a cirurgia bariátrica:fatores pré-operatórios que influenciam nos resultados pós-operatórios / Determinants of success after bariatric surgery: preoperative factorsinfluencing the postoperative results

Introdução: A obesidade, incluída no grupo de doenças crônicasnão-transmissíveis (DCNT), é definida pelo acúmulo excessivo degordura corporal no organismo. A intervenção cirúrgica é colocadacomo o único método de tratamento mais eficaz dessa patologiae leva em consideração os seguintes critérios para sua indicação:IMC, idade e tempo da doença.As práticas nutricionais no períodopré-operatório têm como foco promover modificações no hábito epadrão alimentar, potencializando as chances de obter resultadospositivos e satisfatórios após a cirurgia. Mais pesquisas ainda sãonecessárias para melhor definir os fatores que devem ser priorizadosno pré-operatório a fim de alcançar os resultados desejados.Objetivo: Determinar os fatores sugeridos na literatura como preditoresno pré-operatório que influenciam o resultado após a cirurgiabariátrica.Métodos: Foi realizada busca de artigos publicados no período de2003 a 2014, utilizando-se palavras-chaves em conformidade aosDescritores em Ciências da Saúde, nos idiomas inglês, português eespanhol. A seleção foi baseada nos títulos, resumos e descritores.Resultados: Foram incluídos 66 estudos sendo 12,1% (n=8) dos artigosforam de revisão, 21,2% (n=14) diretrizes e outros 66,6% (n=44)de artigos originais. Os principais fatores encontrados que podeminfluenciar na obtenção de resultados positivos no pós-operatórioforam a prática de atividades físicas, o comparecimento às consultasnutricionais, o Índice de Massa Corporal pré-operatório, a perdade peso pré-operatória e técnica cirúrgica utilizada e a presença decomorbidades.Considerações finais: apesar de identificados os principais fatorespreditores de sucesso pós-operatório, ainda há muita controvérsianos resultados dos estudos relacionados ao tema. Novos estudosdevem ser conduzidos para que os fatores sejam definitivamenteidentificados a fim de que sejam controlados antes da cirurgia contribuindo

Introduction: Obesity, included in the group of chronic non-communicablediseases (NCDs), is defined by excessive accumulation ofbody fat in the body. Surgical intervention is placed as the only methodto more effectively treat this condition and takes into accountthe following criteria for his nomination: BMI, age and disease duration.Nutritional practices in the preoperative period are focusedon promoting changes in habit and dietary patterns, increasing thechances of obtaining positive and satisfactory results after surgery.More research is needed to better define the factors that should beprioritized preoperatively in order to achieve the desired results.Objective: To determine the factors suggested in the literature aspredictors preoperative influencing the outcome after bariatricsurgery.Methods: A search was conducted for articles published in the period2003-2014, using keywords in accordance to Health SciencesDescriptors in English, Portuguese and Spanish languages . The selectionwas based on the titles, abstracts and keywords.Results: 66 studies were included and 12.1% (n = 8) of the articleswere reviews, 21.2% (n = 14) guidelines and other 66.6% (n = 44)were original articles. The main factors that can influence positivelythe postoperatively outcomes were preoperative physical activity,attendance at nutritional consultations, preoperative bodymass index, weight loss, surgical technique and the presence of comorbidities.Conclusion: Although we identified the main predictors for postoperativesuccess, there is still much controversy on the results ofstudies related to the topic. Further studies should be conductedto definitely identify these factores in order to control then beforesurgery and contribute to postoperative success in the short andlong term