Changes in Fat-Free Mass, Protein Intake and Habitual Physical Activity Following Roux-en-Y Gastric Bypass Surgery: A Prospective Study

Dietary protein intake, protein sources & distribution patterns in community-dwelling older adults: A harmonized analysis of eight studies

OBJECTIVES

Sufficient protein intake is important for older adults to prevent sarcopenia. Better insight into dietary characteristics may be helpful to improve daily protein intake. Therefore, this study aimed to compare characteristics of community-dwelling older adults with distinct amounts of daily protein intake.

METHODS

Baseline data of older adults (age >55 years) from eight intervention studies were pooled. Protein intake was measured using 24-h recalls or 3-day food records. Participants were stratified into one of four different groups based on their habitual protein intake (<0.8 g per kilogram bodyweight per day (g/kg/d), 0.8-0.99 g/kg/d, 1.0-1.2 g/kg/d and >1.2 g/kg/d). Protein intake per meal, animal-versus plant-based protein intake, daily protein distribution patterns (e.g. spread or pulse) and the protein intake from distinct protein-rich food categories (meat, fish, dairy, grains and others) were assessed.

RESULTS

Among 814 participants (69 ± 9 years, 54 % male), mean protein intake was 0.98 ± 0.30 g/kg/d. 28 % (n = 227) of the population had a protein intake <0.8 g/kg/d, 29 % (n = 240) 0.8-0.99 g/kg/d, 22 % (n = 179) 1.0-1.2 g/kg/d and 21 % (n = 168) >1.2 g/kg/d. Higher protein intake groups had a lower body weight and BMI and a higher energy intake per day. Although protein intake distribution patterns did not differ across groups, meals with >20 g or >0.4 g protein per kilogram bodyweight per meal more often occurred in the higher protein intake groups. Protein intake was the lowest at breakfast followed by lunch and dinner, in all groups. Higher protein intake groups consumed a higher proportion of animal-based protein sources.

CONCLUSION

Distinct protein intake groups showed comparable intake distribution patterns, with lowest protein consumption at breakfast and highest at dinner. Nevertheless, the highest protein intake group more often consumed >20 gr of protein per meal, indicating that a focus on the absolute amount of protein per meal, particularly at breakfast, could further optimize daily protein intake in older adults.

Protein Supplement Tolerability and Patient Satisfaction after Bariatric Surgery

PURPOSE

Disproportional fat-free mass loss often occurs post-bariatric surgery, partly due to insufficient protein intake during the post-surgery recovery phase. We compared five protein-enhancing strategies (PES) on patient tolerability, satisfaction and protein intake.

MATERIALS AND METHODS

Ninety-four participants, scheduled for bariatric surgery, were enrolled and allocated to either of the following: (1) whey powder, (2) hydrolysed collagen powder, (3) plant-based powder, (4) protein-rich products, (5) protein gel, or control. PES groups were instructed to add 30 g of powder or 2 gels or protein products to their diet. Patient satisfaction and tolerability were evaluated with questionnaires. Dietary intake was assessed prior to and during PES use.

RESULTS

Seven patients dropped out (i.e. loss of contact, personal reasons or post-surgery complications) yielding an analytical cohort of 87 participants. The majority of patients (61%) did not experience dietary complaints from PES and could use PES ≥ 5 days of the week. PES non-usage was mainly related to taste dislike (58%). Hydrolysed collagen scored highest on tolerability and satisfaction: 86% of the participants could use HC ≥ 5 days and 71% were satisfied with the product. PES increased protein intake from 54.7 ± 21.5 g/day to 64.7 ± 23.4 g/day during the intervention (p = 0.002), which differed from the control group (+ 10.1 ± 24.5 g/day vs. - 6.3 ± 23.8 g/day for controls, p = 0.019). Whey showed the highest increase, namely + 18.3 ± 16.3 g/day (p = 0.009).

CONCLUSION

PES were tolerated by the majority of participants, and an improved protein intake with PES use was seen. However, the taste of the products could be improved to further enhance satisfaction and tolerability.

The effects of protein intake higher than the recommended value on body composition changes after bariatric surgery: A meta-analysis of randomized controlled trials

BACKGROUND & AIMS

There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery.

METHODS

Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data.

RESULTS

Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: -9.41 to -0.49) and FM loss by 7.64 kg (95 % CI: -14.01 to -1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: -7.80 kg; 95 % CI: -14.50 to -1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02).

CONCLUSION

The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG.

Prevalence of Perceived Barriers to Physical Activity Among Pre- and Post-Metabolic and Bariatric Surgery Patients: A Cross-Sectional Study

OBJECTIVE

This study aims to describe and compare the prevalence of perceived barriers to physical activity (PBPA) in pre- and post-metabolic and bariatric surgery (MBS) patients and assess the association of these barriers with their physical activity levels.

METHODS

A cross-sectional study included pre-operative (n = 63) and post-operative (n = 119) groups. Sociodemographic characteristics, leisure-time physical activity levels, and PBPA data were collected. Descriptive statistics, chi-square, and Fisher's exact tests, and binomial logistic regression analyses were used for comparisons and associations.

RESULTS

Compared to the pre-operative group, the post-operative group had a lower prevalence of barriers in the physical domain (p = 0.036) and the behavioral domain (p = 0.004). However, there were no significant differences in the environmental (p = 0.531) or social (p = 0.597) domains. Pre-MBS patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.048) and behavioral (p = 0.048) domains. In contrast, post-surgical patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.027), social (p = 0.020), and behavioral (p = 0.037) domains.

CONCLUSION

The results show that individuals who underwent metabolic and bariatric surgery have a lower prevalence of behavioral and physical PBPA compared to those awaiting the procedure. The perception of barriers to physical activity in the environmental and behavioral domains increases the likelihood of physical inactivity in both pre- and post-MBS patients, while in the social domain, it was only associated with physical activity in post-MBS patients.