A Program of Life-Style Modification Improved the Body Weight and Micronutrient Status in Obese Patients After Bariatric Surgery

Overview

Journal Nutrients

Date 2023 Sep 9

PMID 37686839

Authors

Marta Crespo-Yanguas

Jairo Lumpuy-Castillo

Cristina Espadas

Carmen Aragon-Valera

Clotilde Vazquez

Oscar Lorenzo

Affiliations

Soon will be listed here.

Abstract

Introduction: Bariatric surgery is an efficient approach to rapidly reduce morbid obesity and associated comorbidities. However, approximately one-fourth of patients experience weight and comorbidity recurrence, and both obesity and bariatric surgery can lead to micronutrient deficiencies. Implementing a structured program of lifestyle modification (PLM) might enhance weight loss and improve micronutrient status.

Methodology: A total of 121 severely obese patients underwent Roux-en-Y gastric bypass (RYGB). Among them, 71 adhered to a PLM involving dietary changes (low- and very-low-calorie Mediterranean diets) and physical exercises (aerobic and resistance training) both before and after surgery, while 50 patients followed a conventional protocol. Anthropometric measurements and serological parameter quantifications were conducted throughout the procedures.

Results: The obese study population, primarily female (76.9%), with an average age of 47.11 ± 9.68, and a body mass index (BMI) of 44.68 ± 5.08 kg/m, underwent either RYGB with a PLM or a conventional procedure. Before surgery, the PLM group exhibited significant reductions in body weight (6.3%) and phosphoremia compared to the conventional protocol (0.78%). Post-RYGB, the PLM group demonstrated shortened in-hospital stays and further BMI reductions (-16.12 kg/m) that persisted for up to 2 years. Furthermore, the PLM group experienced increased plasma vitamin D levels (14.79 ng/mL vs. 1.2 ng/mL) for up to 2 years, as well as elevated folic acid (1.52 vs. -0.29 ng/mL) and phosphorus (0.48 vs. 0.06 mg/dL) levels at 1 month and 1 year after intervention, respectively. Notably, these effects were independent of weight loss.

Conclusions: Initiating a structured PLM from the early stages of patients' preparation for RYGB could enhance and extend the benefits of weight loss and positively impact micronutrient (vitamin D, phosphorus, and folic acid) status in obese patients.

Citing Articles

Baseline 25(OH)D level is a prognostic indicator for bariatric surgery readmission: a matched retrospective cohort study.

Shang Y, Chen M, Wang T, Xia T Front Nutr. 2024; 11:1362258.

PMID: 38803446 PMC: 11128655. DOI: 10.3389/fnut.2024.1362258.

References

Giordano S, Victorzon M . The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg. 2013; 24(5):669-74. DOI: 10.1007/s11695-013-1165-y. View

Robertson A, Wiggins T, Robertson F, Huppler L, Doleman B, Harrison E . Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg. 2021; 108(8):892-897. DOI: 10.1093/bjs/znab245. View

Ieong K, Ardila-Gatas J, Yang J, Zhang X, Tsui S, Spaniolas K . Bone mineral density changes after bariatric surgery. Surg Endosc. 2020; 35(8):4763-4770. DOI: 10.1007/s00464-020-07953-2. View

Cooper T, Simmons E, Webb K, Burns J, Kushner R . Trends in Weight Regain Following Roux-en-Y Gastric Bypass (RYGB) Bariatric Surgery. Obes Surg. 2015; 25(8):1474-81. DOI: 10.1007/s11695-014-1560-z. View

Osland E, Yunus R, Khan S, Memon M . Five-year Comorbidity Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech. 2023; 33(3):241-248. DOI: 10.1097/SLE.0000000000001156. View

Wolf S, Kenney W . The vitamin D-folate hypothesis in human vascular health. Am J Physiol Regul Integr Comp Physiol. 2019; 317(3):R491-R501. PMC: 6766707. DOI: 10.1152/ajpregu.00136.2019. View

Sabench Pereferrer F, Molina Lopez A, Espelta M, Raga Carceller E, Blanco Blasco S, Buils Vilalta F . Weight Loss Analysis According to Different Formulas after Sleeve Gastrectomy With or Without Antral Preservation: a Randomised Study. Obes Surg. 2016; 27(5):1254-1260. DOI: 10.1007/s11695-016-2454-z. View

Gils Contreras A, Bonada Sanjaume A, Becerra-Tomas N, Salas-Salvado J . Adherence to Mediterranean Diet or Physical Activity After Bariatric Surgery and Its Effects on Weight Loss, Quality of Life, and Food Tolerance. Obes Surg. 2019; 30(2):687-696. DOI: 10.1007/s11695-019-04242-3. View

Berrington de Gonzalez A, Hartge P, Cerhan J, Flint A, Hannan L, MacInnis R . Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010; 363(23):2211-9. PMC: 3066051. DOI: 10.1056/NEJMoa1000367. View

10.

Chakhtoura M, Nakhoul N, Akl E, Mantzoros C, El Hajj Fuleihan G . Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal. Metabolism. 2016; 65(4):586-97. PMC: 4792722. DOI: 10.1016/j.metabol.2015.12.013. View

11.

Mechanick J, Apovian C, Brethauer S, Garvey W, Joffe A, Kim J . Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of.... Obesity (Silver Spring). 2020; 28(4):O1-O58. DOI: 10.1002/oby.22719. View

12.

Berardi G, Vitiello A, Abu-Abeid A, Schiavone V, Franzese A, Velotti N . Micronutrients Deficiencies in Candidates of Bariatric Surgery: Results from a Single Institution over a 1-Year Period. Obes Surg. 2022; 33(1):212-218. PMC: 9834098. DOI: 10.1007/s11695-022-06355-8. View

13.

Castro Vazquez J, Saravia Barahona F, Loureiro Gonzalez C, Leturio Fernandez S, Garcia Fernandez M, Moro Delgado A . Sleeve gastrectomy as a surgical technique in bariatric surgery: Results of safety and effectiveness. Cir Esp (Engl Ed). 2022; 100(2):88-94. DOI: 10.1016/j.cireng.2022.01.002. View

14.

Muscogiuri G, Verde L, Sulu C, Katsiki N, Hassapidou M, Frias-Toral E . Mediterranean Diet and Obesity-related Disorders: What is the Evidence?. Curr Obes Rep. 2022; 11(4):287-304. PMC: 9729142. DOI: 10.1007/s13679-022-00481-1. View

15.

Lespessailles E, Toumi H . Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood). 2017; 242(10):1086-1094. PMC: 5444639. DOI: 10.1177/1535370216688567. View

16.

Greco C, Passerini F, Coluccia S, Teglio M, Bondi M, Mecheri F . Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study. J Endocrinol Invest. 2023; 46(10):2133-2146. DOI: 10.1007/s40618-023-02066-8. View

17.

Jamal M, DeMaria E, Johnson J, Carmody B, Wolfe L, Kellum J . Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2006; 2(2):122-7. DOI: 10.1016/j.soard.2006.01.009. View

18.

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

19.

Csendes A, Burdiles P, Papapietro K, Diaz J, Maluenda F, Burgos A . Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg. 2004; 9(1):121-31. DOI: 10.1016/j.gassur.2004.05.006. View

20.

Barrea L, Muscogiuri G, Laudisio D, Pugliese G, de Alteriis G, Colao A . Influence of the Mediterranean Diet on 25- Hydroxyvitamin D Levels in Adults. Nutrients. 2020; 12(5). PMC: 7284708. DOI: 10.3390/nu12051439. View