Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients.

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.

Higher Muscle Mass and Higher Serum Prealbumin Levels Are Associated with Better Survival in Hemodialysis Patients during a Five-Year Observation Period.

BACKGROUND: Dialysis is the most commonly used renal replacement therapy in patients with end-stage renal disease. The mortality rate of hemodialysis patients is 15-20%, with cardiovascular complications being the most common. There is an association between the severity of atherosclerosis and both the development of protein-calorie malnutrition and inflammatory mediators. The aim of this study was to assess the relationship between biochemical markers of nutritional status, body composition and survival in hemodialysis patients. METHODS: Fifty-three hemodialysis patients were included in the study. Serum albumin, prealbumin, and IL-6 levels were measured, as well as body weight, body mass index, fat content and muscle mass. The five-year survival of patients was calculated using Kaplan-Meier estimators. The long-rank test was used for univariate comparison of survival curves, and the Cox proportional hazards model was used for multivariate analysis of survival predictors. RESULTS: There were 47 deaths, 34 of which were due to cardiovascular disease. The hazard ratio (HR) for age in the middle-aged group (55-65 years) was 1.28 (confidence interval [CI] 0.58, 2.79) and 5.43 (CI 2.1, 14.07; statistically significant) for the oldest age group (over 65 years). A prealbumin level above 30 mg/dl was associated with an HR of 0.45 (CI 0.24, 0.84). Serum prealbumin (odds ratio [OR] = 5.23; CI 1.41, 19.43; p = 0.013) and muscle mass (OR = 7.5; CI 1.31, 43.03; p = 0.024) were significant predictors of all-cause mortality. CONCLUSIONS: Prealbumin level and muscle mass were associated with increased mortality risk. Identification of these factors may improve the survival of hemodialysis patients.

The Impact of the COVID-19 Epidemic on the Mood and Diet of Patients Undergoing Bariatric Surgery.

Limited social contacts, lack of professional activities, economic insecurity, and a sense of threat, as well as boredom during the COVID-19 pandemic, contributed to tension and stress. All of these increase the risk of an inappropriate diet. The aim of this cross-sectional study was to assess the impact of the COVID-19 pandemic on the mood and nutrition of patients undergoing bariatric surgery. A group of 312 patients (both before and after bariatric surgery) completed a questionnaire about their diet and mood during COVID-19 lockdown. About 70% of all respondents reacted to the epidemiological situation: irritability, anxiety about their own health, and eating without being hungry. A total of 74% of all of the subjects snacked between meals (especially sweets). The respondents who believed that obesity and its complications had a negative impact on the prognosis of the coronavirus infection had a statistically significant higher prevalence of health anxiety, feeling that important life issues were out of control, irritability, need for psychological support, and need for dietary consultation. Patients after bariatric surgery had e.g., a statistically significant lower incidence of feeling hungry, eating after meals, and eating fatty foods. The COVID-19 pandemic has been shown to negatively affect the mood and diet of bariatric patients, which may affect their health status and worsen the prognosis of COVID-19.

Nutritional Status, Selected Nutrients Intake and Their Relationship with the Concentration of Ghrelin and Adiponectin in Patients with Diabetic Nephropathy.

BACKGROUND: Overnutrition is one of the risk factors of chronic kidney disease (CKD). The factors related to both obesity and CKD are adiponectin and ghrelin. The aim of the study was to assess if there is a link of nutritional status and selected nutrients intake with adiponectin and ghrelin in patients with diabetic nephropathy (DN). METHODS: The study involved 55 patients diagnosed with DN in the pre-dialysis period (two groups: GFR < 30 and >30 mL/min/1.73 m2). In all participants standard blood tests, total ghrelin and total adiponectin plasma concentrations and anthropometric measurements (BMI, WHR- waist-hip ratio, body composition analysis) were performed. The evaluation of energy and nutrient intakes was made using the three-day food record method. RESULTS: Excessive body weight was found in 92.80% patients. The average daily energy intake was 1979.67 kcal/day (14.45% protein energy, 28.86% fat, and carbohydrates 56.89%). In the group with eGFR < 30 mL/min/1.73 m2 the analysis showed a negative relationship between ghrelin and WHR value, and the creatine and albumin concentrations. There was a positive correlation between ghrelin concentration and the consumption of carbohydrates and sucrose. In the group of patients with eGFR > 30 mL/min/1.73 m2, a positive correlation was found between the concentration of ghrelin and the consumption of vegetable protein, carbohydrates, and glucose. CONCLUSIONS: The study confirms the high prevalence of obesity in patients with DN-Excessive supply of protein was found in the patients' diets, which may contribute to the deterioration of the course of the disease and its prognosis. In patients with eGFR < 30 there was a negative correlation between ghrelin concentration and nutritional status, and in patents with eGFR > 30 between ghrelin concentration and some nutrients intake.

Validity and efficacy of diets used for preoperative weight reduction among patients qualified for bariatric surgery.

INTRODUCTION: Bariatric surgery is the most effective method of weight reduction among patients suffering from morbid obesity. Reduction of body weight before surgery is an important element. The aim of the study was to present the current knowledge on preoperative weight reduction and diet for this purpose. MATERIAL AND METHODS: To achieve the aims of the paper, articles available in the PubMed / MEDLINE database published in 2005-2020 were used, as well as the guidelines of societies such as Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons, American Association of Clinical Endocrinologists, The Obesity Society and American Society for Metabolic & Bariatric Surgery, International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter and European Association for the Study of Obesity. RESULTS: Studies show that even a modest reduction in weight in the early preoperative period facilitates surgery and reduces the number of complications. The available data do not support the effect of preoperative weight loss on increased postoperative weight loss. The use of balanced, energy-restricted diet in the preoperative period prepares the patient for changes in the way of nutrition, which improves the nutritional status of patient. Low calorie (LCD) or very low calorie (VLCD) diet can be an effective method of weight loss before surgery, however, this approach does not allow to modify eating habits. The use of a very low calorie ketogenic diet (VLCKD) remains under discussion. CONCLUSIONS: There is a need for large randomized trials to assess short and long term benefits of preoperative weight loss and methods of weight loss among patients qualified for bariatric surgery, also the standardization of nutritional management in the preoperative period.

Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Bariatric and metabolic surgery care standards.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

XXL-TYPE PERSONALITY. Personality traits promoting excess body weight.

THE AIM OF THE STUDY: The study aimed to determine whether persons suffering from obesity may be characterised by specific personality traits which promote the development of excess body weight. Additionally, the aim involved finding whether persons suffering from morbid obesity differed from healthy individuals and somatic patients as regards selected personality traits. MATERIAL AND METHODS: The study enrolled 34 patients with the diagnosis of morbid obesity in the process of qualification for surgical treatment of obesity. The patients' BMI ranged from 35 to 54 kg/m2. Study participants completed NEO-FFI personality inventory (Costa, McCare; 1998) and the authors' questionnaire designed to collect demographic data and anthropometric measurements. R esults: The study showed that patients with morbid obesity significantly differed from healthy individuals and somatic patients as regards the analysed measurements of the Big Five. C onclusions: The traits which were significantly distinctive in morbidly obese patients included lowered conscientiousness and increased neuroticism. The results indicate that the above pattern of personality traits may promote the development of excessive body weight.

The association between proinflammatory cytokines and kidney function, body composition, and nutritional markers in nondialysis-dependent chronic kidney disease patients with diabetes mellitus type 2
.

BACKGROUND: Chronic kidney disease (CKD) is associated with a subclinical inflammatory state, which contributes to increased mortality in CKD patients. The purpose of this study was to examine the association between chosen cytokines, such as IFN-γ, IL-10, IL-2p70, IL-6, and kidney function as well as the body composition and nutritional markers in patients with CKD and diabetes mellitus type 2. MATERIALS AND METHODS: 21 patients with diabetes mellitus type 2 and CKD stage 3b - 5, with estimated glomerular filtration rate (eGFR) lower than 45 mL/min/1.72m2, not being treated with dialysis were included in the study. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor - Fresenius Medical Care). RESULTS: Significant, negative correlations between lean tissue index (LTI) and IFN-γ concentrations (r = -0.52, p = 0.021) as well as IL-6 concentrations (r = -0.46, p = 0.047) were observed. Only the IL-6 levels significantly correlated with kidney function expressed by eGFR (r = -0.47, p = 0.034). We observed a significant positive correlation between IL-6 level and IFN-γ (r = 0.51, p = 0.019) as well as with high-sensitivity C-reactive protein (hsCRP) levels (r = 0.48, p = 0.029). The IL-10 level significantly correlated with hsCRP (r = 0.53, p = 0.015). CONCLUSION: In CKD patients with diabetes mellitus type 2 during conservative treatment, IL-6 levels were associated with kidney function expressed by eGFR. IL-6 levels and IFN-γ levels negatively correlated with the amount of muscle mass. Cytokines did not show any association with the amount of fat tissue this study.

Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment.

Eating is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed when eating (or not eating) and associated body weight gain anxiety become the main interest of an individual and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are health- and life-threatening for patients.

Dietary and Pharmacological Treatment of Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the developed world. Simple hepatic steatosis is mild, but the coexistence of steatohepatitis (NASH) and fibrosis increases the risk of hepatocellular carcinoma. Proper dietary and pharmacological treatment is essential for preventing NAFLD progression. The first-line treatment should include dietary intervention and increased physical activity. The diet should be based on the food pyramid, with a choice of products with low glycemic index, complex carbohydrates in the form of low-processed cereal products, vegetables, and protein-rich products. Usage of insulin-sensitizing substances, pro- and prebiotics, and vitamins should also be considered. Such a therapeutic process is intended to support both liver disease and obesity-related pathologies, including insulin resistance, diabetes, dyslipidemia, and blood hypertension. In the pharmacological treatment of NAFLD, apart from pioglitazone, there are new classes of antidiabetic drugs that are of value, such as glucagon-like peptide 1 analogs and sodium/glucose cotransporter 2 antagonists, while several other compounds that target different pathogenic pathways are currently being tested in clinical trials. Liver biopsies should only be considered when there is a lack of decline in liver enzymes after 6 months of the abovementioned treatment. Dietary intervention is recommended in all patients with NAFLD, while pharmacological treatment is recommended especially for those with NASH and showing significant fibrosis in a biopsy.

Assessment of health behaviors, nutritional behaviors, and self-efficacy in patients with morbid obesity. / Ocena zachowan zdrowotnych, zywieniowych i poczucia wlasnej skutecznosci chorych z otyloscia olbrzymia.

OBJECTIVES: The objective of the study was to assess the frequency of health and nutritional behaviors concerning emotional, habitual, and restrictive eating as well as to evaluate self efficacy in patientswith morbid obesity and determine the correlation between patients'BMI index and their health behaviors as well as self-efficacy. METHODS: The study included 37 patients diagnosed with class two and three obesity, aged 18-62 (M = 39.94; SD = 12.20). Patients' BMI ranged from 36 to 60 kg/m2 (M = 43.50; SD = 5.36). Research tools used in the study: the Inventory of Lifestyle Behaviors (ILB), the Dietary Behaviors Questionnaire (DBQ), and the General Self-Efficacy Scale (GSES). RESULTS: Patients with morbid obesity were characterized by medium (men; a sten score of 5) and low (women; a sten score of 4) intensity of health behaviors. Subjects showed a tendency for negative nutritional behaviors, emotional and habitual eating as well as dietary restrictions. General self-efficacy ranged between sten scores of 4 to 10, with mean at a high level (a sten score of 7). CONCLUSIONS: Patients with morbid obesity need health, nutritional, and psychological education.

Content of fatty acids in a diet and the homocysteine levels in women with fertility disorders.

OBJECTIVES: Assessment of the effects of consumption of fatty acids on the homocysteine levels in women with fertility disorders. METHODS AND RESULTS: The study included 286 women at the age between 23 and 46 years (the mean 33.13±4.21 years) with a fertility disorders. We measured: levels of homocysteine [µmol/L] (n=171), body weight and height (n=286). Body mass index (BMI) was calculated. A diet was assessed by 3-day dietary food records method including one day of the weekend. The mean homocysteine (Hcy) levels were 10.02±2.98 µmol/L. Body weight excess was observed in 29.3% of subjects. The percentage of fatty acids in the total energy [%E] it was demonstrated that the mean rate of MUFAs and PUFAs was statistically significantly lower in diets of women with the homocysteine levels >15 µmol/L compared to the group with the Hcy <10 µmol/L. Based on the results of a correlation between the homocysteine levels and consumption of n-6 fatty acids and n-3 fatty acids it is possible to conclude that there are negative correlations observed indicating that higher consumption of these acids is associated with lower levels of homocysteine. CONCLUSION: Increased consumption of PUFAs, including α-linoleic acid, in a diet seems to be an important factor preventing from hyperhomocysteinemia.

[Non-alcoholic liver disease - diagnosis and treatment]. / Stluszczeniowa niealkoholowa choroba watroby ­ diagnostyka i leczenie.

Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in the developed world (15% to 40% of the adult population). Introduction of lifestyle changes including dietary intervention and increased physical activity is most often the first-line treatment and is intended to support not only the treatment of liver disease, but also for diseases associated with obesity, insulin resistance, diabetes and dyslipidemia. In addition to well-known metformin, there are new classes of antidiabetic drugs, including GLP-1analog, SGLT-2 antagonist, pioglitazon. In addition, statins, vitamin E and pentoxyfiline are also recommended. In the absence of improvement of liver enzymes during the 6 months of treatment, liver biopsy should be considered. Simple hepatic steatosis (NAFL) is mild, but steatohepatitis (NASH) and fibrosis chance the prognosis and the risk of hepatocellular carcinoma (HCC) is higher.

Stress as a factor contributing to obesity in patients qualified for bariatric surgery - studies in a selected group of patients (a pilot study).

INTRODUCTION: Recently, the incidence of obesity, especially extreme obesity, has significantly increased. It is connected with inappropriate lifestyle, including a high calorie diet, psychological and genetic factors, some medications, diseases or infectious factors. Nowadays, the consumption of food is not only to satisfy a physiological need, but also fulfils psychological needs. The most effective method of morbid obesity treatment is metabolic surgery. Moreover, food is considered to be a reward and method of coping with stress. In order to improve the efficiency of the surgical treatment, it seems significant to assess the effects of psychological factors on eating behaviours. AIM: To evaluate the effects of stress on eating habits that increase the risk of extreme obesity. MATERIAL AND METHODS: The study included 50 subjects qualified for bariatric surgery. The authors' own questionnaire and standardised PSS-10 questionnaire by Cohen, Kamarcki and Mermelstein adapted by Juczynski and Oginska-Bulik were used. RESULTS: These questionnaires indicated that patients felt a moderate levels of stress but with a tendency for high levels. The majority of respondents declared an increased appetite due to stress-causing factors. Reasons for snacking most frequently included negative emotions and feeling like eating something. Consumption of additional snacks was a way of coping with stress. Most frequently the subjects ate sweets and salty snacks, but also sandwiches, nuts, fruit and alcohol beverages. CONCLUSIONS: Psychological support may help morbidly obese people both to change nutritional habits and to cope with stress.

[Dietetary recommendation for non-alcoholic fatty liver disease]. / Zalecenia zywieniowe dla chorych z niealkoholowa stluszczeniowa choroba watroby.

Non-alcoholic Fatty Liver Disease (NAFLD) is currently the most common chronic liver disease in the developed world. Nowadays, in the adult population of Europe it is estimated at 14% to 21%. Its most important risk factors are obesity and metabolic syndrome. Introducing lifestyle changes such as: dietary intervention and increased physical activity are the first-line treatment and are intended to support not only NAFLD but also associated diseases such as obesity, insulin resistance, diabetes and dyslipidemia. Dietary management focuses on weight reduction of overweight or obese people by decreasing energy in diet. It is recommended to limit the intake of saturated fats and trans fatty acids as well as cholesterol. Instead, it is important to increase the proportion of polyunsaturated fatty acid diets, mainly from the n-3 family, which exhibit anti-inflammatory activity. It is also beneficial to eat nuts, despite their high energy value, as a source of alpha linolenic acid, which lowers LDL cholesterol. It is important to increase the share of vegetable protein (eg. soya) and limit the intake of fat meat, milk and the dairy products. A key role in the treatment and prevention of NAFLD is also a reduction of simple sugars and total exclusion of added sugar in the diet. The rise of NAFLD in developed countries is analogous to the increase of fructose consumption, which high intake is directly indicated as the main cause of the disease. Choosing foods with high fiber content, low glycemic index and meals composed with low glycemic load, is conducive to weight reduction. An important role in supporting NAFLD treatment is also attributed to vitamin D, C and E supplementation and some probiotic bacteria, as well as cinnamon and turmeric, which improve insulin sensitivity. Daily physical activity is strongly recommended as the supplement of healthy lifestyle.

[Nutritional behavior of chosen group of school children in aspect of obesity risk]. / Zachowania zywieniowe wybranej grupy dzieci w wieku szkolnym w aspekcie zagrozenia otylocia.

The research was conducted by questionnaire method among children aged 7-9 y. and teenagers aged 13-15 y. The results of the study show that regularity of meals was better in children group. Dietary habits linked to obesity are large volumes of sweets, sweetened drinks, few vegetables, milk products and fish. Taking results into consideration it is probably schoolchildren are at obesity risk. The most important prevention factor is nutrition education.

[Selected lifestyle characteristic of patients with extreme obesity qualified for bariatric surgery]. / Wybrane cechy trybu zycia pacjentów z otyloscia olbrzymia zakwalifikowanych do operacji bariatrycznych.

The aim of the study was the analysis of chosen nutritional habits and physical activity among patients qualified for bariatric surgery. The research was conducted by questionnaire method. The results of the study show that number and regularity of meals was improper. Everybody snack, eg. sweets. About 50% of researched read information on the food packages, but only few participants paid attention to the nutritional and energy value of food products. TV and radio were the main source of nutritional information. Nutritional behaviors men and women were different. The level of physical activity was low.

Pro-health nutritional behaviors of selected group of students of the Medical University of Warsaw.

The aim of the study was the analysis of pro-health nutritional behaviors among 100 female students Medical University of Warsaw tested by the questionnaire method. The results of the study show that nutritional behaviors of students who learned human nutrition were significantly better in accordance with dietary guidelines. The most frequent consumed group of products were fruits and dairy products. Consumption of vegetables, number and regularity of meals had been better among dietetics students then among midwifery and nursing students.