Orosensory Perception of Fat/Sweet Stimuli and Appetite-Regulating Peptides before and after Sleeve Gastrectomy or Gastric Bypass in Adult Women with Obesity.

The aim of this study was to explore the impact of bariatric surgery on fat and sweet taste perceptions and to determine the possible correlations with gut appetite-regulating peptides and subjective food sensations. Women suffering from severe obesity (BMI > 35 kg/m2) were studied 2 weeks before and 6 months after a vertical sleeve gastrectomy (VSG, n = 32) or a Roux-en-Y gastric bypass (RYGB, n = 12). Linoleic acid (LA) and sucrose perception thresholds were determined using the three-alternative forced-choice procedure, gut hormones were assayed before and after a test meal and subjective changes in oral food sensations were self-reported using a standardized questionnaire. Despite a global positive effect of both surgeries on the reported gustatory sensations, a change in the taste sensitivity was only found after RYGB for LA. However, the fat and sweet taste perceptions were not homogenous between patients who underwent the same surgery procedure, suggesting the existence of two subgroups: patients with and without taste improvement. These gustatory changes were not correlated to the surgery-mediated modifications of the main gut appetite-regulating hormones. Collectively these data highlight the complexity of relationships between bariatric surgery and taste sensitivity and suggest that VSG and RYGB might impact the fatty taste perception differently.

Prevalence and Determinants of Nutritional Deficiencies at Mid-Term After Sleeve Gastrectomy.

BACKGROUND: Several studies reported a risk of nutritional deficiencies after sleeve gastrectomy (SG). Systematic long-term multivitamin (MV) supplementation after SG is recommended by guidelines but not followed in practice in France. OBJECTIVES: To assess the determinants of nutritional status at 2 years or more after SG in patients treated or not with MV. METHODS: Nutritional parameters were prospectively recorded in our database from 2004. All patients who came back in our institution for follow-up at 2 years or more after SG were included. The last visit available was selected. Systematic MV was stopped at 1 year after SG except if there is risk of malnutrition. A deficiency was defined by a biological deficit or the need for a specific supplement, prescribed in accordance with biological deficit. RESULTS: One hundred forty-seven patients were included with a mean follow-up of 44 ± 17 months: 39 were still taking MV and 108 had stopped MV. Caloric and protein intake was lower, and albumin deficiencies were more frequent in patients still taking MV, as expected. The total number of deficiencies was not significantly different before and after SG even in patients without MV (3.7 ± 1.8 vs. 3.5 ± 1.8), but patients without MV tended to have more group B vitamin deficiencies after surgery. The main determinants of postoperative deficiencies were preoperative concentrations. CONCLUSION: Nutritional deficiencies are not more common after than before SG, even among patients who stopped MV. The interest of targeted supplementation in patients with deficiencies rather than systematic supplementation after SG needs to be confirmed by randomized studies.

What Are the Micronutrient Deficiencies Responsible for the Most Common Nutritional Symptoms After Bariatric Surgery?

BACKGROUND: Many patients complain of nutritional symptoms after bariatric surgery (BS), including hair loss, cramps, and paresthesia, but their link with biological alterations has been poorly studied. OBJECTIVES: To assess in a large cohort of subjects the relationship between nutritional symptoms and biological deficits both in the short term (ST ≤ 1 year) and long term (LT ≥ 3 years) after the 2 most common procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: Nutritional symptoms and biological parameters (including vitamins, minerals, and protein parameters) were prospectively recorded. All subjects with complete clinical and biological assessments from 2011 to 2018 were included. RESULTS: After BS, 555 subjects were studied in the ST (50% RYGB) and 494 in the LT (79% RYGB); multivitamin intake was 97% and 78%, respectively. The proportion of patients with hair loss decreased from 65 (ST) to 35% (LT) (p < 0.001). In contrast, cramps increase from 7 to 32% and paresthesia from 11 to 18% (p < 0.001). No significant difference was found between SG and RYGB. In subjects with hair loss, blood parameters of protein and iron metabolism were significantly lower than in subjects without hair loss, both in the ST and LT. In contrast, neither zinc nor group B vitamin levels were significantly different. None of the nutritional parameters tested was clearly associated with cramps and paresthesia. CONCLUSION: After BS, the most frequent nutritional symptom is hair loss, essentially linked to iron and protein deficiencies. The causes of other nutritional symptoms are less clear and probably more heterogeneous.

Effectiveness of Ursodeoxycholic Acid in the Prevention of Cholelithiasis After Sleeve Gastrectomy.

PURPOSE: The use of ursodeoxycholic acid (UDCA) to prevent gallstone formation after sleeve gastrectomy (SG) is still debated. Furthermore, no study has assessed the effectiveness of UDCA on gallstone formation after the first postoperative year. Our aim was to compare the incidence of cholelithiasis (CL) at 1 and 3 years after SG between patients treated or not treated with UDCA. MATERIALS AND METHODS: From January 2008, a postoperative ultrasound monitoring was scheduled for all patients who underwent SG in our institution. Patients with a preoperative intact gallbladder who performed at least one ultrasound at 1 year after SG were included. We compared the incidence of CL between patients operated before October 2013 who did not receive UDCA and those operated from October 2013 who received UDCA 500 mg once daily for 6 months postoperatively. RESULTS: The incidence of CL at 1 year after SG was 28% in the 46 non-treated and 3.5% in the 143 treated patients (p < 0.001). UDCA reduced the proportion of cholecystectomies from 11% to 1.4% (p = 0.012). Thus, the number of patients needed to treat to avoid a cholecystectomy was about 10. Only 2 patients (1.4%) stopped UDCA for adverse effects. No gallstone appeared at 3 postoperative years in the 61 patients who performed an ultrasound at this time. CONCLUSION: UDCA 500 mg once daily for 6 months postoperatively is effective and well tolerated to prevent CL at midterm after SG. We recommend UDCA treatment in all patients after SG with an intact preoperative gallbladder. However, large randomized studies are needed to establish guidelines for prevention of gallstone formation after SG.

Gastric bypass specifically impairs liver parameters as compared with sleeve gastrectomy, independently of evolution of metabolic disorders.

BACKGROUND: Numerous studies have shown that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differently affect metabolic disorders associated with obesity. While bariatric surgery has been shown to improve nonalcoholic fatty liver disease, very few studies have compared liver parameters after both procedures. OBJECTIVES: To compare the evolution of liver parameters after SG and RYGB and their relationships with improvement of metabolic disorders. METHODS: Metabolic parameters and abdominal ultrasonography were recorded before and 1 year after bariatric surgery in all patients who underwent SG or RYGB between 2004 and 2016 in our institution. SETTING: University hospital, Colombes, France. RESULTS: Five hundred thirty-three patients (15% men, age 43 ± 11 yr) were analyzed, including 326 who underwent RYGB and 207 who underwent SG. Before surgery, body mass index (44.7 ± 5.7 versus 44.4 ± 7.4 kg/m²) and metabolic parameters were not significantly different. One year after surgery, RYGB induced greater weight loss (31.9 ± 7.7 versus 28.6 ± 8.3 %, P < .001). Metabolic parameters improved in both groups, but fasting insulin, low-density lipoprotein cholesterol, C-reactive protein, and ferritin were lower after RYGB (P < .001). In contrast, transaminases were higher after RYGB compared with SG (alanine aminotransferase: 31.6 ± 18.7 versus 22.6 ± 7.7 IU/L; P < .001). The persistence of alanine aminotransferase >34 IU/L (27% versus 7% of patients, P < .001) was independent of the persistence of steatosis on ultrasonography (39% versus 37% of patients) 1 year after RYGB and SG, respectively. CONCLUSION: Despite a greater improvement of metabolic disorders, RYGB has less beneficial effect on liver parameters compared with SG. Further studies are required to define the mechanisms explaining these differences between both procedures.

Impact of Roux-en-Y gastric bypass and sleeve gastrectomy on fetal growth and relationship with maternal nutritional status.

BACKGROUND: There is a lack of evidence on whether sleeve gastrectomy (SG), which induces fewer nutritional deficiencies than Roux-en-Y gastric bypass (RYGB), also affects fetal growth (FG). OBJECTIVES: To compare neonatal outcomes after RYGB and SG and to assess the impact of maternal nutritional alterations on FG after both procedures. SETTING: University Hospital, France. METHODS: Women with singleton pregnancies who had at least 1 nutritional evaluation in our institution between 2004 and 2017 were included. FG was assessed with birth weight (BW) and BW-Z score (adjusted for sex and term), and maternal nutritional deficiencies were defined according to standard and pregnancy-specific norms. RESULTS: During the study period 123 pregnancies were included, 77 after RYGB and 46 after SG. Weight loss was higher after RYGB than after SG (45.6 ± 12.4 versus 39.5 ± 13.7 kg, P = .02), but mean weight before pregnancy and weight gain during pregnancy were similar. Mean BW (3026 ± 677 versus 3162 ± 712 g), mean BW Z-score and incidence of small for gestational age (24% versus 19%) were not significantly different after RYGB and SG. Mean number of nutritional deficiencies during the second trimester was similar (2.2 ± 1.5 versus 2.1 ± 1.2 with specific norms), but the affected parameters differed between procedures. Urinary urea (R = .285, P = .04) was positively correlated to BW Z-score after both procedures. In contrast, serum iron parameters were negatively associated to BW Z-score. CONCLUSION: FG restriction occurs after both SG and RYGB. FG after bariatric surgery is positively associated with protein supply and negatively correlated with maternal iron status.

Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study.

BACKGROUND: Evolution of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) is controversial. Some authors report worsening or improvement of preoperative GERD, others the occurrence of de novo GERD between 5 and 69%. AIMS: The aims of this study are to evaluate the evolution of GERD after SG by ambulatory 24-h pH monitoring (APM) and to determine pre- and postoperative clinical and manometric factors associated with its evolution. METHODS: Between 2013 and 2015, 47 patients operated in our center performed APM before and 1 year (14.8 ± 4.9 months) after SG. GERD was defined as a percentage of time with esophageal pH < 4 (TpH < 4) > 4.2. Among them, 30 had pre- and postoperative high-resolution esophageal manometry (HRM). RESULTS: Thirty-one patients (66%) had no preoperative GERD (group 1), and 16 had preoperative GERD (group 2). One year after SG, mean TpH < 4 increased significantly in group 1 (5.8 ± 4.6 vs. 1.8 ± 1.1%, p < 0.01) whereas it was not modified in group 2 (7.4 ± 6.6 vs. 6.6 ± 2.6%). In group 1, 16 patients (52%) had de novo GERD whereas in group 2, 7 had no more GERD, 3 improved, and 6 worsened. Maximal intragastric pressure after swallows increased significantly at postoperative HRM only in patients with de novo GERD (49.2 ± 22.0 vs. 25.4 ± 9.4 mmHg, p = 0.03). No preoperative clinical or manometric parameters were predictive of postoperative GERD. CONCLUSIONS: One year after SG, esophageal acid exposure globally worsened, mostly because of de novo GERD, whereas 63% patients with preoperative GERD improved, without preoperative predictive clinical or manometric factor.

Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid.

BACKGROUND: The use of ursodeoxycholic acid (UDCA) to prevent gallstone formation after gastric bypass (RYGB) is still debated. Furthermore, only 1 study has assessed the effectiveness of UDCA after sleeve gastrectomy (SG) with mitigated results. OBJECTIVES: To compare the incidence of cholelithiasis (CL) between patients treated or not treated with UDCA after RYGB and SG. SETTING: University hospital, France. METHODS: Since January 2008, a postoperative ultrasound monitoring was scheduled for all patients without previous cholecystectomy who underwent bariatric surgery in our institution. Patients who underwent at least 1 ultrasound in the first postoperative year (±6 months) were included. We started to systematically prescribe UDCA (500 mg/d) for 6 months postoperatively, in February 2012 for RYGB (once or twice daily) and in October 2013 for SG (once daily). RESULTS: Mean follow-up was 13.0±3.4 months. The incidence of CL was 32.5% in the 117 nontreated RYGB and 25.5% in the 51 nontreated SG. It was reduced to 2.4% in the 42 SG treated once daily (P = .005), to 5.7% in the 87 RYGB with 250 mg twice daily (P<.001), but only to 18.6% in the 102 RYGB with 500 mg once daily (P = .03). CONCLUSION: UDCA 500 mg once daily for 6 months is efficient to prevent CL 1 year after SG, but the twice-daily doses seem to be more effective after RYGB. The effectiveness of UDCA once daily after SG and the superiority of the twice-daily doses after RYGB should be confirmed with more patients and longer follow-up.

Determinants of Evolution of Glomerular Filtration Rate After Bariatric Surgery: a 1-Year Observational Study.

BACKGROUND: Many studies have shown that hyperfiltration induced by obesity decreases after bariatric surgery, while others also showed an increase in glomerular filtration rate (GFR). Furthermore, the factors that influence GFR after bariatric surgery have been poorly studied. The objective was to study the impact of bariatric surgery on renal function and clarify the factors that determine the evolution of GFR after surgery. METHODS: We prospectively evaluated GFR (assessed with 24-h urinary clearance of creatinine) in all patients who underwent bariatric surgery between 2004 and 2014, before and 1 year after surgery. The links between GFR changes and usual clinical and biological parameters were studied. RESULTS: Three hundred twenty-three patients with complete urine datasets were included (age 43 ± 11 year, M/F 49/274, BMI 46 ± 7 kg/m2). Excess weight loss was 61 ± 24 % and body surface area (BSA) decreased from 2.26 ± 0.23 to 1.98 ± 0.21 m2 (p < 0.001). Mean GFR decreased from 133 ± 37 to 122 ± 49 ml/min (p < 0.001), in parallel to weight loss. However, GFR decreased in subjects with a preoperative GFR >120 ml/min (p < 0.001), was stable in those with 90 < GFR < 120 ml/min, and increased in those with GFR <90 ml/min (p < 0.01). In multivariate analysis, postoperative GFR did not correlate with metabolic parameters but correlated positively with BSA (p < 0.001) and protein intake (p < 0.01) and negatively with age (p < 0.001) and persistence of antihypertensive drugs (p < 0.001) after surgery. CONCLUSION: GFR decreased after bariatric surgery in subjects with hyperfiltration, but increased in subjects with renal failure. Changes in body mass, protein intake, and blood pressure appeared to be the main determinants of GFR evolution after surgery.

Relevance of Self-reported Behavioral Changes Before Bariatric Surgery to Predict Success After Surgery.

BACKGROUND: International guidelines emphasize the need for multidisciplinary preparation to improve the safety and effectiveness of bariatric surgery (BS), but whether the patient is ready for surgery is difficult to assess. The objective of this study was to explore whether inquiries on dietary habits and physical activity before surgery are predictive of postoperative weight loss. METHODS: We prospectively assessed in 78 candidates for BS (age, 43 ± 12 years; M/F, 15/63; weight, 122 ± 17 kg; IMC, 44 ± 5 kg/m2) anthropometric parameters, food intake, and physical activity (Baecke questionnaire) at the beginning and the end of a systematized preoperative preparation (7 ± 2 months) including consultations (mean number 7 ± 2) with a nutritionist, dietician, psychologist, and sports coach. RESULTS: During the preparation, weight change was zero (±5 kg). In contrast, self-reported caloric intake decreased from 2143 ± 640 to 1906 ± 564 kcal/24 h (p < 0.001) and snacking from 68 to 13% during the preparation. Self-reported physical activity increased (p < 0.05). The decrease in reported caloric intake was positively correlated with the mean number of preoperative consultations attended (R = 0.2885, p < 0.05) but not with the changes in preoperative weight. Postsurgical weight loss (recorded at 6 and 12 months) was correlated with preoperative changes in weight and physical activity but not with preoperative dietary changes. CONCLUSIONS: Self-reported improvement of dietary habits is not a good reflection of actual changes in dietary behavior among candidates for bariatric surgery, as illustrated by the absence of weight changes on average during the preoperative preparation. In contrast to dietary inquiry, self-reported changes in physical activity are predictive of postoperative weight loss after bariatric surgery.

Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass in obese patients: a prospective study.

BACKGROUND: Although the risk of cholelithiasis (CL) increases in patients after Roux-en-Y gastric bypass (RYGB), no prospective study has yet assessed the incidence of CL after sleeve gastrectomy (SG). OBJECTIVES: To compare, prospectively, the incidence and predictive factors for CL after both procedures. METHODS: A postoperative abdominal ultrasound follow-up was proposed to all patients with an intact gallbladder and who underwent RYGB or SG in Hôpital Louis Mourier from 2008 onward. RESULTS: At least one ultrasound was performed on one hundred and sixty patients between 6 and 12 months postsurgery, 43 after SG and 117 after RYGB. Age, gender, initial body-mass index, co-morbidities were similar in both groups. Weight loss (WL) at 6 months was significantly lower after SG than after RYGB (26.9 ± 9.2 and 31.3 ± 7.5 kg, respectively = .001). The incidences of CL after SG and RYGB were similar (28% versus 34% respectively, P = .57). Most cases of CL occurred in the first year post surgery. During the follow-up, 12% and 13% of patients who underwent SG and RYGB, respectively, became symptomatic. WL of>30 kg at 6 months was a risk factor for CL after bariatric surgery, but we did not find any preoperative predictive factor for gallstone formation. CONCLUSIONS: Despite lower WL after SG, the incidence of CL after SG and RYGB was similar at 2 years. Our results suggest that rapid WL is the main element leading to gallstone formation after both procedures.