Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations

Overview

Journal Obes Surg

Date 2017 Jul 13

PMID 28699068

Citations 6

Authors

Shiri Sherf-Dagan

Keren Hod

Assaf Buch

Limor Mardy-Tilbor

Ziva Regev

Tair Ben-Porat

Nasser Sakran

David Goitein

Asnat Raziel

Affiliations

Soon will be listed here.

Abstract

Introduction: Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS, based on our clinical experience and current scientific literature in both nutrition fields.

Methods: Cross-sectional analysis of a prospectively maintained database of all primary laparoscopic sleeve gastrectomies (LSG) performed at a bariatric center of excellence between January 2014 and November 2016 was carried out querying patients who declared a vegetarian or vegan lifestyle before surgery. Preoperative data collected included demographics, anthropometrics, dietary patterns, supplementation use, physical activity, smoking habits, co-morbidities, and blood tests. Each vegetarian was matched to five different omnivores based on age, gender, and BMI.

Results: During the study period, 1470 patients underwent primary LSG surgery (63.7% females). Twenty-one declared a vegetarian or vegan lifestyle (1.4%) pre-surgery. Most were classified as lacto-ovo (57.1%) and were driven from ethical reasons (85.7%). No differences were found between vegetarian and omnivore LSG candidates regarding co-morbidities and nutritional deficiencies, except for lower prevalence of impaired fasting glucose (14.3 vs. 47.1%;P = 0.007), lower ferritin levels (54.3 ± 50.5 vs. 96.8 ± 121.8 ng/ml; P = 0.052) and higher transferrin levels (313.9 ± 42.7 vs. 278.4 ± 40.4 mg/dl; P = 0.009) among the vegetarian cohort. Preoperative use of vitamin B12 and iron supplementation was higher among vegetarian LSG candidates than their omnivore counterparts (57.1 vs. 6.7%;P < 0.001 and 23.8 vs. 6.7%; P = 0.015, respectively).

Conclusions: Vegetarians have comparable health status and nutritional deficiencies, lower iron stores, and higher supplementation use before surgery compared to omnivore LSG candidates.

Citing Articles

Nutritional Status of Vegetarian Patients Before and After Bariatric Surgery: a Monocentric Retrospective Observational Case-Control Study.

Phan A, Hage M, Zaharia R, Vigan M, Coursault S, Wilson S Obes Surg. 2023; 33(5):1356-1365.

PMID: 36991254 DOI: 10.1007/s11695-023-06538-x.

Precision nutrition in the context of bariatric surgery.

Aguas-Ayesa M, Yarnoz-Esquiroz P, Olazaran L, Gomez-Ambrosi J, Fruhbeck G Rev Endocr Metab Disord. 2023; 24(5):979-991.

PMID: 36928810 PMC: 10020075. DOI: 10.1007/s11154-023-09794-5.

Lower Non-Heme Iron Absorption in Healthy Females from Single Meals with Texturized Fava Bean Protein Compared to Beef and Cod Protein Meals: Two Single-Blinded Randomized Trials.

Mayer Labba I, Hoppe M, Gramatkovski E, Hjellstrom M, Abdollahi M, Undeland I Nutrients. 2022; 14(15).

PMID: 35956338 PMC: 9370477. DOI: 10.3390/nu14153162.

Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice.

Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C Adv Nutr. 2020; 12(3):1020-1031.

PMID: 33040143 PMC: 8262552. DOI: 10.1093/advances/nmaa121.

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery.

Martinez-Ortega A, Olveira G, Pereira-Cunill J, Arraiza-Irigoyen C, Garcia-Almeida J, Irles Rocamora J Nutrients. 2020; 12(7).

PMID: 32640531 PMC: 7400832. DOI: 10.3390/nu12072002.

References

Craig W, Mangels A . Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009; 109(7):1266-82. DOI: 10.1016/j.jada.2009.05.027. View

Schupbach R, Wegmuller R, Berguerand C, Bui M, Herter-Aeberli I . Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. Eur J Nutr. 2015; 56(1):283-293. DOI: 10.1007/s00394-015-1079-7. View

Isom K, Andromalos L, Ariagno M, Hartman K, Mogensen K, Stephanides K . Nutrition and metabolic support recommendations for the bariatric patient. Nutr Clin Pract. 2014; 29(6):718-39. DOI: 10.1177/0884533614552850. View

Langan R, Zawistoski K . Update on vitamin B12 deficiency. Am Fam Physician. 2011; 83(12):1425-30. View

Kessler C, Holler S, Joy S, Dhruva A, Michalsen A, Dobos G . Personality Profiles, Values and Empathy: Differences between Lacto-Ovo-Vegetarians and Vegans. Forsch Komplementmed. 2016; 23(2):95-102. DOI: 10.1159/000445369. View

Carrodeguas L, Kaidar-Person O, Szomstein S, Antozzi P, Rosenthal R . Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2006; 1(6):517-22. DOI: 10.1016/j.soard.2005.08.003. View

Smelt H, Pouwels S, Smulders J . Different Supplementation Regimes to Treat Perioperative Vitamin B12 Deficiencies in Bariatric Surgery: a Systematic Review. Obes Surg. 2016; 27(1):254-262. DOI: 10.1007/s11695-016-2449-9. View

Moize V, Pi-Sunyer X, Mochari H, Vidal J . Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010; 20(8):1133-41. DOI: 10.1007/s11695-010-0160-9. View

Dyett P, Sabate J, Haddad E, Rajaram S, Shavlik D . Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices. Appetite. 2013; 67:119-24. DOI: 10.1016/j.appet.2013.03.015. View

10.

Mechanick J, Youdim A, Jones D, Garvey W, Hurley D, McMahon M . Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American.... Obesity (Silver Spring). 2013; 21 Suppl 1:S1-27. PMC: 4142593. DOI: 10.1002/oby.20461. View

11.

Schollenberger A, Karschin J, Meile T, Kuper M, Konigsrainer A, Bischoff S . Impact of protein supplementation after bariatric surgery: A randomized controlled double-blind pilot study. Nutrition. 2015; 32(2):186-92. DOI: 10.1016/j.nut.2015.08.005. View

12.

Spencer E, Appleby P, Davey G, Key T . Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003; 27(6):728-34. DOI: 10.1038/sj.ijo.0802300. View

13.

Faria S, Faria O, Buffington C, Cardeal M, Ito M . Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011; 21(11):1798-805. DOI: 10.1007/s11695-011-0441-y. View

14.

Pawlak R, Lester S, Babatunde T . The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr. 2014; 68(5):541-8. DOI: 10.1038/ejcn.2014.46. View

15.

Kim J, Kim D, Roh Y, Ju S, Nam H, Nam G . Serum Ferritin Levels Are Positively Associated With Metabolically Obese Normal Weight: A Nationwide Population-Based Study. Medicine (Baltimore). 2015; 94(52):e2335. PMC: 5291611. DOI: 10.1097/MD.0000000000002335. View

16.

Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Sandbank G . Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr. 2017; 8(2):382-394. PMC: 5347111. DOI: 10.3945/an.116.014258. View

17.

Cole A, Beckman L, Earthman C . Vitamin D status following bariatric surgery: implications and recommendations. Nutr Clin Pract. 2014; 29(6):751-8. DOI: 10.1177/0884533614546888. View

18.

Jastrzebska-Mierzynska M, Ostrowska L, Wasiluk D, Konarzewska-Duchnowska E . Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery. Rocz Panstw Zakl Hig. 2015; 66(1):13-9. View

19.

Pellitero S, Martinez E, Puig R, Leis A, Zavala R, Granada M . Evaluation of Vitamin and Trace Element Requirements after Sleeve Gastrectomy at Long Term. Obes Surg. 2017; 27(7):1674-1682. DOI: 10.1007/s11695-017-2557-1. View

20.

Aparicio-Ugarriza R, Palacios G, Alder M, Gonzalez-Gross M . A review of the cut-off points for the diagnosis of vitamin B12 deficiency in the general population. Clin Chem Lab Med. 2014; 53(8):1149-59. DOI: 10.1515/cclm-2014-0784. View