Most of qualitative dietary changes observed one year post-bariatric surgery can be achieved with a preoperative dietary intervention / La mayoría de los cambios dietéticos un año después de la cirugía bariátrica pueden conseguirse con una intervención nutricional preoperatoria

Background and objectives: Bariatric surgery (BS) leads to several changes in nutritional habits that can be attributed to different mechanisms. Some of these changes could be achievable with a preoperative nutritional intervention. The objective was to evaluate dietary modifications during the preoperative and postoperative periods of BS. Methods: Prospective observational study of patients who underwent BS between 2010 and 2014 at the Hospital del Mar; 60 consecutive patients were included. Food consumption was measured by a validated food-frequency questionnaire at inclusion in the bariatric surgery program, after preoperative nutritional intervention, and one year after surgery. Generalized estimating equation models were used to assess differences in food group intake during follow up. Results: Energy intake significantly decreased from inclusion to 1 year of surgery (p = 0.003). After the preoperative intervention and prior to surgery, there was an increase in intake of nuts, vegetables, poultry and rabbit, fruit, fish and skimmed milk products and a decrease in bread, soft drinks and pastry. At one year post-surgery, a continued decrease in the consumption of bread and soft drinks and an increase in nuts was observed (linear non-quadratic trend). Consumption of fruit, pastry, fish and skimmed milk products remained stable showing a linear and quadratic trend. Vegetables and poultry and rabbit increased in the preoperative period and decreased after surgery, showing a quadratic but not linear trend. Conclusions: a preoperative nutritional intervention in morbidly obese patients can associate favorable dietary changes that are mostly maintained one year after bariatric surgery

Introducción y objetivos: La cirugía bariátrica produce diferentes cambios en los hábitos alimentarios que se han atribuido a diferentes mecanismos. Algunos de estos cambios se podrían conseguir con una intervención nutricional preoperatoria. El objetivo fue estudiar los cambios dietéticos durante el periodo preoperatorio y postoperatorio de la cirugía bariátrica. Métodos: Estudio prospectivo de pacientes intervenidos de cirugía bariátrica entre los años 2010 y 2014 en el Hospital del Mar de Barcelona. Se incluyeron 60 pacientes consecutivos. El registro de alimentos se midió mediante cuestionarios de frecuencia de consumo de alimentos a la inclusión en el programa de cirugía bariátrica, después de una intervención nutricional preoperatoria y un año después de la cirugía. Se usaron las ecuaciones de estimación generalizadas para determinar diferencias en el consumo de los grupos de alimentos durante el seguimiento. Resultados: El consumo de energía disminuyó desde la inclusión un año después de la intervención (p = 0,003). En el periodo preoperatorio y antes de la cirugía se detectó un aumento en el consumo de frutos secos, vegetales, aves y conejo, fruta, pescado y lácticos desnatados y un descenso en el consumo de pan, bebidas azucaradas y bollería. Un año después de la cirugía, se observó que el consumo de pan y bebidas azucaradas siguió descendiendo y el de frutos secos siguió aumentando (tendencia lineal pero no cuadrática). El consumo de fruta, pescado y lácticos desnatados se mantuvo estable (tendencia lineal y cuadrática). El consumo de vegetales, aves y conejo aumentó en el periodo preoperatorio y disminuyó después de la cirugía (tendencia cuadrática pero no lineal). Conclusiones: Una intervención nutricional preoperatoria en pacientes con obesidad mórbida puede asociarse a cambios dietéticos favorables, los cuales se mantienen en su mayoría un año después de la intervención

Most of qualitative dietary changes observed one year post-bariatric surgery can be achieved with a preoperative dietary intervention.

BACKGROUND AND OBJECTIVES: Bariatric surgery (BS) leads to several changes in nutritional habits that can be attributed to different mechanisms. Some of these changes could be achievable with a preoperative nutritional intervention. The objective was to evaluate dietary modifications during the preoperative and postoperative periods of BS. METHODS: Prospective observational study of patients who underwent BS between 2010 and 2014 at the Hospital del Mar; 60 consecutive patients were included. Food consumption was measured by a validated food-frequency questionnaire at inclusion in the bariatric surgery program, after preoperative nutritional intervention, and one year after surgery. Generalized estimating equation models were used to assess differences in food group intake during follow up. RESULTS: Energy intake significantly decreased from inclusion to 1 year of surgery (p=0.003). After the preoperative intervention and prior to surgery, there was an increase in intake of nuts, vegetables, poultry and rabbit, fruit, fish and skimmed milk products and a decrease in bread, soft drinks and pastry. At one year post-surgery, a continued decrease in the consumption of bread and soft drinks and an increase in nuts was observed (linear non-quadratic trend). Consumption of fruit, pastry, fish and skimmed milk products remained stable showing a linear and quadratic trend. Vegetables and poultry and rabbit increased in the preoperative period and decreased after surgery, showing a quadratic but not linear trend. CONCLUSIONS: a preoperative nutritional intervention in morbidly obese patients can associate favorable dietary changes that are mostly maintained one year after bariatric surgery.

Characterization of the pattern of food consumption in severely obese patients prior to bariatric surgery / Caracterización del patrón de consumo de alimentos en pacientes con obesidad severa antes de la cirugía bariátrica

Introduction: severe obesity is increasing rapidly in several countries, as well as the number of bariatric surgeries performed. However, the pattern of food consumption of the population is not well defined. Objectives: the aim of the present study was to describe the food consumption pattern (comparing men and women) of severely obese patient candidates to bariatric surgery and to determine the promoting and protecting factors. Methods: food consumption and nutrient intake were measured by a validated food frequency questionnaire (FFQ), including food and beverages. Multivariate principal component analysis (PCA) was done to analyze the component that best relates to the food pattern consumption dividing the different food groups in promotors and protectors. Results: significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery were found. A positive correlation was found between the food groups that are protective factors for obesity such as the fiber (r = 0.84), vegetables (r = 0.767) and fruits (r = 0.83), whereas a negative correlation was found with those factors that are promotors of obesity such as fats (r = -0.341), saturated fats (r = -0.411), soft drinks (r = -0.386), and fast food (r = -0.17).Multivariate analysis of principal components revealed that calorie consumption is the component that correlates better with the pattern. Conclusions: there are significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery and these differences should be taken into account when planning nutritional intervention. Therefore, a healthy lifestyle behaviour should be highly encouraged among the severe obese population

Introducción: la obesidad mórbida así como el número de cirugías bariátricas que se practican van en aumento en varios países. Sin embargo, el patrón de consumo alimentario de estos pacientes no está bien definido. Objetivos: describir el patrón de consumo de alimentos (comparando hombres y mujeres) de pacientes con obesidad severa candidatos a cirugía bariátrica y determinar los factores promotores y protectores de la obesidad. Métodos: el consumo de alimentos y la ingesta de nutrientes se midieron mediante un cuestionario de frecuencia de consumo de alimentos validado que incluye alimentos y bebidas. Se realizó un análisis multivariado de componentes principales para determinar qué componente se relaciona mejor con el consumo de patrones alimentarios promotores y protectores de obesidad. Resultados: el estudio mostró diferencias significativas en el patrón de consumo de alimentos entre hombres y mujeres. Se encontró una correlación positiva entre los grupos de alimentos considerados factores de protección para la obesidad, como la fibra (r = 0,84), las verduras (r = 0,767) y las frutas (r = 0,83), mientras que la correlación fue negativa con los factores promotores de la obesidad como las grasas (r = -0,341), las grasas saturadas (r = -0,411), los refrescos (r = -0,386) y la comida rápida (r = -0,17). El análisis multivariado de los componentes principales reveló que el consumo de calorías es el componente que se correlaciona mejor con el patrón. Conclusiones: existen diferencias significativas en el patrón de consumo de alimentos entre hombres y mujeres con obesidad severa y estas deben tenerse en cuenta al planificar la intervención nutricional. Asimismo, un consumo alimentario saludable debe promocionarse en la población obesa

Characterization of the pattern of food consumption in severely obese patients prior to bariatric surgery.

INTRODUCTION: Introduction: severe obesity is increasing rapidly in several countries, as well as the number of bariatric surgeries performed. However, the pattern of food consumption of the population is not well defined. Objectives: the aim of the present study was to describe the food consumption pattern (comparing men and women) of severely obese patient candidates to bariatric surgery and to determine the promoting and protecting factors. Methods: food consumption and nutrient intake were measured by a validated food frequency questionnaire (FFQ), including food and beverages. Multivariate principal component analysis (PCA) was done to analyze the component that best relates to the food pattern consumption dividing the different food groups in promotors and protectors. Results: significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery were found. A positive correlation was found between the food groups that are protective factors for obesity such as the fiber (r = 0.84), vegetables (r = 0.767) and fruits (r = 0.83), whereas a negative correlation was found with those factors that are promotors of obesity such as fats (r = -0.341), saturated fats (r = -0.411), soft drinks (r = -0.386), and fast food (r = -0.17).Multivariate analysis of principal components revealed that calorie consumption is the component that correlates better with the pattern. Conclusions: there are significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery and these differences should be taken into account when planning nutritional intervention. Therefore, a healthy lifestyle behaviour should be highly encouraged among the severe obese population.

INTRODUCCIÓN: Introducción: la obesidad mórbida así como el número de cirugías bariátricas que se practican van en aumento en varios países. Sin embargo, el patrón de consumo alimentario de estos pacientes no está bien definido. Objetivos: describir el patrón de consumo de alimentos (comparando hombres y mujeres) de pacientes con obesidad severa candidatos a cirugía bariátrica y determinar los factores promotores y protectores de la obesidad. Métodos: el consumo de alimentos y la ingesta de nutrientes se midieron mediante un cuestionario de frecuencia de consumo de alimentos validado que incluye alimentos y bebidas. Se realizó un análisis multivariado de componentes principales para determinar qué componente se relaciona mejor con el consumo de patrones alimentarios promotores y protectores de obesidad. Resultados: el estudio mostró diferencias significativas en el patrón de consumo de alimentos entre hombres y mujeres. Se encontró una correlación positiva entre los grupos de alimentos considerados factores de protección para la obesidad, como la fibra (r = 0,84), las verduras (r = 0,767) y las frutas (r = 0,83), mientras que la correla-ción fue negativa con los factores promotores de la obesidad como las grasas (r = -0,341), las grasas saturadas (r = -0,411), los refrescos (r = -0,386) y la comida rápida (r = -0,17). El análisis multivariado de los componentes principales reveló que el consumo de calorías es el componente que se correlaciona mejor con el patrón. Conclusiones: existen diferencias significativas en el patrón de consumo de alimentos entre hombres y mujeres con obesidad severa y estas deben tenerse en cuenta al planificar la intervención nutricional. Asimismo, un consumo alimentario saludable debe promocionarse en la población obesa.

Preoperative predictors of weight loss at 4 years following bariatric surgery.

BACKGROUND: This study evaluated the influence of patient characteristics, preoperative weight loss, and type of surgical procedure on long-term weight loss after bariatric surgery (BS). METHODS: Subjects were a prospective cohort of 95 patients who underwent BS with 4 years of follow-up. Seventy-seven patients (81.1%) underwent laparoscopic Roux-en-Y gastric bypass, and 18 (18.9%) had laparoscopic sleeve gastrectomy. Age, gender, initial body mass index (BMI), preoperative percentage of excess weight loss, presence of type 2 diabetes mellitus, current smoking status, and surgical technique were analyzed via multivariate linear regression analysis to identify predictors of weight loss during the 4 years after the surgery. RESULTS: Maximum percentage of excess weight loss was obtained at 18 months. Age and preoperative BMI were negatively associated with percentage of excess weight loss at 1, 2, 3, and 4 years after BS (P < .005). At 4 years, laparoscopic Roux-en-Y gastric bypass was independently associated with a higher weight loss than laparoscopic sleeve gastrectomy (P < .05). CONCLUSIONS: Younger age, lower BMI, and laparoscopic Roux-en-Y gastric bypass are independent predictors of long-term weight loss after BS.

Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient?

BACKGROUND: Bariatric surgery has been shown to be effective in resolving co-morbid conditions even in patients with a body mass index (BMI)<35 kg/m(2). A question arises regarding the metabolic benefits of bariatric surgery in metabolically healthy but morbidly obese (MHMO) patients, characterized by a low cardiometabolic risk. The objective of this study was to assess the effects of bariatric surgery on cardiometabolic risk factors among MHMO and metabolically unhealthy morbidly obese (MUMO) adults. METHODS: A nonrandomized, prospective cohort study was conducted on 222 severely obese patients (BMI>40 kg/m(2)) undergoing either laparoscopic roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. Patients were classified as MHMO if only 1 or no cardiometabolic factors were present: high blood pressure, triglycerides, blood glucose (or use of medication for any of these conditions), decreased high-density lipoprotein-cholesterol (HDL-C) levels, and insulin resistance defined as homeostasis model assessment for insulin-resistance (HOMA-IR)> 3.29. RESULTS: Forty-two (18.9%) patients fulfilled the criteria for MHMO. They were younger and more frequently female than MUMO patients. No differences between groups were observed for weight, BMI, waist and hip circumference, total and LDL-C. MHMO patients showed a significant decrease in blood pressure, plasma glucose, HOMA-IR, total cholesterol, LDL-C and triglycerides and an increase in HDL-C 1 year after bariatric surgery. Weight loss 1 year after bariatric surgery was similar in both groups. CONCLUSION: Eighteen percent of patients with morbid obesity fulfilled the criteria for MHMO. Although cardiovascular risk factors in these patients were within normal range, an improvement in all these factors was observed 1 year after bariatric surgery. Thus, from a metabolic point of view, MHMO patients benefited from bariatric surgery.

Utilidad de la escala Obesity surgery mortality risk score en la predicción de complicaciones tras cirugía bariátrica por vía laparoscópica / Obesity surgery mortality risk score for the prediction of complications after laparoscopic bariatric surgery

INTRODUCCIÓN: La morbimortalidad tras la cirugía bariátrica varía según las características de los pacientes y las comorbilidades asociadas. El objetivo de este estudio fue evaluar la posible utilidad de la escalaObesity sugery mortality risk score (OS-MRS) para prever el riesgo de complicaciones postoperatorias tras cirugía bariátrica. MÉTODOS: Estudio retrospectivo de una serie prospectiva de pacientes intervenidos de cirugía bariátrica a los que se aplicó antes de la operación la escala OS-MRS. Se clasificaron las complicaciones postoperatorias siguiendo la propuesta de Dindo-Clavien. Se analizó la relación entre las categorías de la escala OS-MRS: A) bajo riesgo; B) riesgo intermedio y C) riesgo elevado, y la presencia de complicaciones. RESULTADOS: Entre mayo del 2008 y junio del 2012 se incluyó a 198 pacientes (85 [42,9%] a los que se realizó un bypass gástrico y 113 [57,1%] con una gastrectomía vertical). Utilizando la escala OS-MRS, 124 pacientes se clasificaron como clase A (62,6%), 70 como clase B (35,4%) y 4 como clase C (2%). La tasa de morbilidad global fue del 12,6% (25 pacientes). Se demostró una asociación significativa entre la escala OS-MRS y la tasa de complicaciones (7,3, 20 y 50%, respectivamente; p = 0,004). El bypass gástrico se asociaba a mayor número de complicaciones que la gastrectomía vertical (p = 0,007). En el análisis multivariado, la escala OS-MRS y la técnica quirúrgica fueron los únicos factores con valor predictivo. CONCLUSIONES: La escala OS-MRS es una herramienta útil para predecir el riesgo de complicaciones y puede orientar a la hora de escoger el tipo de cirugía bariátrica

INTRODUCTION: Morbimortality after bariatric surgery varies according to patient characteristics and associated comorbidities. The aim of this study was to evaluate the usefulness of the obesity surgery mortality risk score scale (OS-MRS) to predict the risk of postoperative complications after bariatric surgery. METHODS: A retrospective study was performed on a prospective series of patients undergoing bariatric surgery in which the OS-MRS scale was applied preoperatively. Postoperative complications were classified as proposed by Dindo-Clavien. We analysed the relationship between the categories of OS-MRS scale: (A) low risk, (B) intermediate risk, and (C) high risk and the presence of complications. RESULTS: Between May 2008 and June 2012, 198 patients were included (85 [42.9%] after gastric bypass and 113 [57.1%] after sleeve gastrectomy). Using the OS-MRS scale, 124 patients were classified as class A (62.6%), 70 as class B (35.4%) and 4 as class C (2%). The overall morbidity rate was 12.6% (25 patients). A significant association between OS-MRS scale and rate of complications (7.3, 20 and 50%, respectively, P=.004) was demonstrated. The gastric bypass was associated with a higher complication rate than sleeve gastrectomy (P=.007). In multivariate analysis, OS-MRS scale and surgical technique were the only significant predictive factors. CONCLUSIONS: The OS-MRS scale is a useful tool to predict the risk of complications and can be used as a guide when choosing the type of bariatric surgery

Obesity surgery mortality risk score for the prediction of complications after laparoscopic bariatric surgery.

INTRODUCTION: Morbimortality after bariatric surgery varies according to patient characteristics and associated comorbidities. The aim of this study was to evaluate the usefulness of the Obesity sugery mortality risk score scale (OS-MRS) to predict the risk of postoperative complications after bariatric surgery. METHODS: A retrospective study was performed of a prospective series of patients undergoing bariatric surgery in which the OS-MRS scale was applied preoperatively. Postoperative complications were classified as proposed by Dindo-Clavien. We analyzed the relationship between the categories of OS-MRS scale: A) low risk, B) intermediate risk, and C) high risk and the presence of complications. RESULTS: Between May 2008 and June 2012, 198 patients were included (85 [42.9%] after gastric bypass and 113 [57.1%] after sleeve gastrectomy). Using the OS-MRS scale, 124 patients were classified as class A (62.6%), 70 as class B (35.4%) and 4 as class C (2%). The overall morbidity rate was 12.6% (25 patients). A significant association between OS-MRS scale and rate of complications (7.3, 20 and 50%, respectively, P=.004) was demonstrated. The gastric bypass was associated with a higher complication rate than sleeve gastrectomy (P=.007). In multivariate analysis, OS-MRS scale and surgical technique were the only significant predictive factors. CONCLUSIONS: The OS-MRS scale is a useful tool to predict the risk of complications and can be used as a guide when choosing the type of bariatric surgery.

Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome.

BACKGROUND: A substantial number of patients undergoing bariatric surgery are lost to follow-up for unknown reasons, which may cause an overestimation of the benefits of operation. The aim of this study was to identify the reasons of failure to attend controls after bariatric surgery and the relationship with poor weight loss. METHODS: A retrospective analysis of a prospective database including all patients undergoing bariatric surgery from January 2004 to February 2012 was performed. Nonadherence was defined as missing any scheduled control visit for more than 6 months. Contact was attempted (mail, telephone, and e-mail), and responders were requested to complete a questionnaire. RESULTS: Forty-six (17.5%) out of 263 patients were considered nonadherent. Thirty-three (71.7%) of these patients completed the questionnaire. The main reasons for nonadherence were work- (36.4%) and family-related (18.2%) problems or having moved outside the city or to the country (15.2%). The percentage of nonadherent patients aged ≤45 years was greater as compared with those aged >45 years [28 (60.1%) vs 18 (42.2%), respectively, P = 0.034]. Likewise, of the 30 patients with unsuccessful weight loss (<50% EWL), seven (30.4%) were in the nonadherent group while 23 (10.6%) in the adherent group (P = 0.046). Finally, 96.9% of patients were completely satisfied with surgery and would recommend the procedure to other morbid obese patients. CONCLUSION: The nonadherence rate to follow-up visits after bariatric surgery was 17.5%, mainly associated with work-related problems. Nonadherence was greater in patients aged ≤45 years and in those with poor weight loss.

Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are associated with glucose metabolism improvement although data on insulin resistance remission rates after these procedures are lacking. AIMS: Primary aim was to compare insulin resistance remission rates achieved after LRYGB and LSG, using population-specific HOMA-IR cut-off points. Secondary objectives were to analyze factors associated with type 2 diabetes mellitus (T2DM) complete remission according to the new American Diabetes Association criteria and to examine changes in HOMA-B during follow-up. METHODS: Non-randomized, prospective cohort study of patients undergoing LRYGB or LSG with a minimal follow-up of 24 months. Patients on insulin therapy were excluded. RESULTS: At baseline, 56 (48.7%) of the 115 LRYGB group and 48 (61.5%) of the 78 LSG group had insulin resistance, and 29 (25.2%) and 20 (25.6%) T2DM, respectively. No differences were detected in insulin resistance remission rate (92.9% LRYGB and 87.5% LSG, p = 0.355) nor in T2DM complete remission at 2 years (62.1 vs 60% respectively, p = 0.992). Factors independently associated with T2DM complete remission were diabetes treatment and a greater decrease in 3-month HOMA-IR index. The HOMA-B index showed a progressive decline during follow-up. CONCLUSION: Both surgical techniques are equally effective in achieving insulin resistance normalization in the majority of severely obese patients. Three-month HOMA-IR reduction after surgery was the main predictor of T2DM complete remission.

Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been gaining acceptance because it has shown good short- and mid-term results as a single procedure for morbid obesity. The aim of this study was to compare short- and mid-term results between laparoscopic Roux-en-Y gastric bypass (LRYGB) and LSG. METHODS: Observational retrospective study from a prospective database of patients undergoing LRYGB and LSG between 2004 and 2011, where 249 patients (mean age 44.7 years) were included. Patients were followed at 1, 3, 6, 12, and 18 months, and annually thereafter. Short- and mid-term weight loss, comorbidity improvement or resolution, postoperative complications, re-interventions, and mortality were evaluated. RESULTS: One hundred thirty-five LRYGB and 114 LSG were included. Significant statistical differences between LRYGB and LSG were found in operative time (153 vs. 93 min. p < 0.001), minor postoperative complications (21.5 % vs. 4.4 %, p = 0.005), blood transfusions (8.8 % vs. 1.7 %, p = 0.015), and length of hospital stay (4 vs. 3 days, p < 0.001). There were no differences regarding major complications and re-interventions. There was no surgery-related mortality. The percentage of excess weight loss up to 4 years was similar in both groups (66 ± 13.7 vs. 65 ± 14.9 %). Both techniques showed similar results in comorbidities improvement or resolution at 1 year. CONCLUSIONS: There is a similar short- and mid-term weight loss and 1-year comorbidity improvement or resolution between LRYGB and LSG, although minor complication rate is higher for LRYGB. Results of LSG as a single procedure need to be confirmed after a long-term follow-up.