Bariatric surgery and long-term nutritional issues

Short-term impact of bariatric surgery on the dietary intake of patients with type 2 diabetes

BACKGROUND

The prevalence of overweight and obesity and an unhealthy diet and lifestyle are the key causes of rising diabetes burden in India. Bariatric surgery is gaining popularity in India as a favored approach to manage obesity and its accompanying comorbidities. Despite this, there is a scarcity of Indian studies evaluating dietary intake. Our goal was to analyse the dietary intake of Indian patients with type 2 diabetes mellitus (T2DM) who have undergone laparoscopic sleeve gastrectomy (LSG) or duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) or surgeries.

METHODS

The longitudinal observational study included 64 T2DM patients (32 in each procedure) enrolled through purposive sampling. The patients underwent surgery (LSG or DJB-SG procedure) between January 2017 and July 2019. Dietary data was collected at baseline and postsurgery (12 months) using a 24-h dietary recall method for 2 days (one working and one holiday).

RESULTS

The total sample consisted of 27 (42.2%) females and 37 (57.8%) males. The mean age was 46.8 years. At 12 months, the follow-up for the LSG and DJB-SG procedures was 100% and 78%, respectively. In the short term, a significant reduction was seen in weight, body mass index and haemoglobin A1C (HbA1C) in both surgical groups. The two procedures were comparable with respect to weight loss but improvement in glycaemia was higher in the DJB-SG group. The dietary intake (food groups and nutrients) was similar in the two surgical groups at baseline and 12 months postsurgery. Dietary intake assessment showed significant reduction in calorie dense foods (cereals, roots and tubers, fats and oils, table sugar, and biscuits) in both surgical groups. Among nutrients, intake of energy, fats, carbohydrates, dietary fibre, thiamine, riboflavin, niacin, folate and iron were reduced significantly in both procedures. Vitamin D (84.4% patients in LSG group and 81.3% patients in DJB-SG) and iron (62.5% patients in LSG group and 68.8% patients in DJB-SG) were commonly prevalent nutritional deficiencies at baseline and were significantly reduced at 12 months.

CONCLUSIONS

In the short term, bariatric surgery resulted in weight loss and improvement in glycaemia. Bariatric surgery does significantly affect dietary intake leading to nutritional deficiencies. Therefore, patients should be recommended vitamin and mineral supplements and regular patient education and counselling by a trained bariatric dietitian to prevent nutritional deficiencies and maintain nutritional status.

Barriers to and enablers of modifying diet after metabolic bariatric surgery: A systematic review of published literature

This is a qualitative systematic review in which we investigated barriers and enablers influencing dietary behavior change after metabolic bariatric surgery (MBS). Database searches retrieved publications reporting perceived factors influencing dietary behavior change post-MBS. Data (quotes, survey results, interpretative summaries) were extracted and analyzed using combined deductive and inductive thematic analyses. The generated barrier/enabler themes mapped to the Theoretical Domains Framework and then behavior change techniques to identify potential strategies to improve post-operative dietary behavior. Thirty-four publications were included. Key barriers fell within the domains of 'Environmental Context and Resources' (e.g., insufficient and unreliable healthcare services), 'Behavioral Regulation' (e.g., lack of self-discipline), 'Emotions' (e.g., eating as a strategy to overcome negative emotions), 'Beliefs about Consequences' (e.g., the extent of realistic expectations from MBS), and 'Social Influences' (e.g., challenge of eating at social events). Key enablers were also identified within 'Environmental Context and Resources' (e.g. self-access internet-based resources), 'Behavioral Regulation' (e.g. learning how to develop new dietary strategies), 'Beliefs about Consequences' (e.g., positive impacts of surgery-induced food intolerances), and 'Social Influences' (e.g., support from social/group sessions). Potential strategies to change postoperative dietary behavior include social support, problem-solving, goal setting, and self-monitoring of behavior. This provides insight into the targets for future post-operative nutrition-focused interventions.

Long-Term Follow-Up After Bariatric Surgery: Key to Successful Outcomes in Obesity Management

Background/Objectives: Bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity. To achieve optimal long-term results, continuous follow-up (FU) within a multidisciplinary treatment team is essential to ensure patient compliance and maximize the benefits of BS. However, many patients find it difficult to maintain regular FU, which can affect the quality of care and lead to postoperative complications. This review aims to highlight factors that may hinder compliance with FU after BS, examine potential causes and consequences of inadequate FU, and identify strategies to improve patient participation in long-term FU. Methods: The literature search was conducted between October 2023 and June 2024 in Medline (PubMed) and the Cochrane Library datasets. Studies were selected for their relevance to adherence to FU, multidisciplinary approaches, and long-term bariatric outcomes. Results: The pre- and postoperative period is critical for educating patients and healthcare team members about the importance of FU, addressing potential barriers (e.g., logistical, psychological, and social challenges), and highlighting the risk of relapse to obesity after surgery. The lack of a standardized FU protocol leads to differences between medical centers, further impacting patient adherence. Conclusions: Tailored and regularly updated strategies are essential to address individual patient needs and improve adherence to FU. Further research is needed to identify the specific factors that influence variability in long-term BS outcomes, highlighting the need for a patient-centered approach to obesity treatment.

Micronutrient Status in Patients with Severe Obesity Before and After Laparoscopic Sleeve Gastrectomy

Background: Micronutrient deficiencies (MNDs) are commonly reported after bariatric and metabolic surgery, including laparoscopic sleeve gastrectomy (LSG). Nevertheless, the micronutrient status changes over time and the influence of sex or initial body mass index (BMI) on these changes are less explored. This study aims to investigate the changes in micronutrient levels at 6 and 12 months after LSG and the potential influence of sex or baseline BMI (≥40 kg/m2) on these changes in patients submitted to LSG. Additionally, the frequency of MNDs before and at 12 months after the procedure was investigated. Materials and methods: Fifty patients with obesity underwent LSG and were assessed anthropometrically and nutritionally at baseline and at 6 and 12 months, respectively, after LSG. The changes in micronutrients levels over time were tested by a linear mixed model. Results: Vitamin B12 and vitamin D [25(OH)D] did not change significantly, while iron (p < 0.001), calcium (p = 0.01), and parathormone (p < 0.001) differed significantly from baseline to 12 months after LSG. Ferritin significantly decreased from baseline to 6 months and 12 months after LSG (LS-means, 95% CI: 202 [163, 240] vs. 160 [130, 191] vs. 150 [115, 185]). Sex or initial severe obesity (BMI ≥ 40 kg/m2) exhibited significant modifying effects for 25(OH)D and calcium, respectively. The 25(OH)D levels increased significantly in men, but not in women, while the calcium plasma concentration changed significantly only in patients with initial severe obesity. No significant changes over time were found for MNDs' frequency (p > 0.05). The most consistent deficiency frequency was observed for 25(OH)D both before and after LSG. Conclusions: Overall, our findings revealed changes in micronutrient status across the follow-up period, except for vitamin B12. Variations in 25(OH)D levels were reported exclusively in men, suggesting that they depend on sex. The calcium plasma concentration showed significant changes exclusively in patients with BMI ≥ 40 kg/m2. MNDs' frequency was not significantly altered during the study follow-up. Our results reinforce the need for developing national dietary guidelines tailored for Romanian patients following LSG.

Nutritional status of Saudi obese patients undergoing laparoscopic sleeve gastrectomy, one-year follow-up study

Bariatric surgery has significantly increased globally as an effective treatment for severe obesity. Nutritional deficits are common among candidates for bariatric surgery, and follow-up of nutritional status is critically needed for post-surgery healthcare management. This observational prospective study was conducted at King Khalid University Hospital in Riyadh. Samples were collected pre- and post-laparoscopic sleeve gastrectomy (LSG), with the visit intervals divided into four visits: pre-surgery (0M), 3 months (3M), 6 months (6M) and 12 months (12M). Food intake and eating patterns significantly changed during the first year (P < 0·001). The mean energy intake at 3M post-surgery was 738·3 kcal, significantly lower than the pre-surgery energy intake of 2059 kcal. Then, it increased gradually at 6M and 12M to reach 1069 kcal (P < 0·00). The intake of Fe, vitamin B12 and vitamin D was below the dietary reference intake recommendations, as indicated by the 24-hour dietary recall. The prevalence of 25 (OH) vitamin D deficiency improved significantly from pre- to post-surgery (P < 0·001). Vitamin B12 deficiency was less reported pre-LSG and improved steadily towards a sufficient post-surgery status. However, 35·7 % of participants were deficient in Fe status, with 28·6% being female at higher levels than males. While protein supplementation decreased significantly over the 12M follow-up, the use of vitamin supplements dramatically increased at 3 and 6M before declining at 12M. Fe and vitamin B12 were the most popular supplements after vitamin D. This study confirms the necessity for individualised dietary plans and close monitoring of candidates' nutritional status before and after bariatric surgery.

Religious Fasting Following Metabolic and Bariatric Surgery (MBS): Insights from Jewish Practices in Israel

Background and Objectives: Religious fasting in patients after Metabolic and Bariatric Surgery (MBS) remains a topic with limited clarity. This study aims to present the results of a survey on religious fasting in patients after MBS in Israel. The questionnaire was sent to members of the Israeli Society for Metabolic and Bariatric Surgery (ISMBS). Materials and Methods: An online questionnaire survey was designed and distributed to members of the ISMBS. The survey consisted of 23 questions addressing religious fasting in patients after MBS and was divided into three sections: (1) MBS surgeon clinical experience, (2) clinical considerations regarding religious fasting in MBS patients, and (3) fasting-related complications in MBS patients. Responses were recorded and presented as numbers (percentages), with results analyzed descriptively and/or graphically. Results: The ISMBS has 63 active members, and 37 members (59%) responded to the survey. Most respondents have more than 10 years of MBS experience and perform more than 100 MBS procedures annually (67.5% and 54%, respectively). In general, 81.1% of respondents permit religious fasting in patients after MBS, and 73% think that fasting could be safe at least 12 months after MBS. Most (62.2%) agree that a clinical evaluation should be undertaken prior to permitting religious fasting; 40% of respondents note that there is increased patient admission to emergency rooms during religious fasting, mostly due to dehydration. When asked about fasting risks, most noted hypoglycemia (40.5%) and the evolution of marginal ulcers (16.2%). Conclusions: In conclusion, these national survey results emphasize the variations in MBS surgeons' opinions regarding religious fasting after MBS. Despite these differences, there were still many similarities in responses such as timing and fasting permission, and this study could aid clinicians in the future when consulted on religious fasting by MBS patients.

Effectiveness of a Nurse-Led Telecare Programme in the Postoperative Follow-Up of Bariatric Surgery Patients: A Quasi-Experimental Study

BACKGROUND/OBJECTIVES

Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery.

METHODS

A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions.

RESULTS AND CONCLUSIONS

The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients.

Effect of bariatric surgery on postoperative outcomes of total hip arthroplasty: An updated systematic review and meta-analysis

Bariatric surgery may cause complications following total hip arthroplasty (THA); however, the evidence remains unclear. This review aims to evaluate the effects of bariatric surgery on THA complications. A systematic search of PubMed, EMBASE, Scopus, and Cochrane databases was performed. The eligibility criteria were cohort studies comparing THA patients with and without prior bariatric surgery. The primary outcomes were complications, length of hospital stay, readmission rate, and cost. The study quality was assessed using the MINORS criteria. The meta-analysis was performed using Review Manager 5.4. Nine cohort studies (170,882 patients) met our inclusion criteria. Bariatric surgery was not associated with the risk of dislocation at 90 days (OR 1.50, 95%CI 0.83, 2.70). However, at one-year follow-up, the dislocation rate was significantly lower in the NBS group (OR 1.51, 95%CI 1.23, 1.86). Bariatric surgery reduced the risk of periprosthetic fracture risk (OR 0.56, 95%CI, 0.33 to 0.96) but had no effect on infection (RR 0.96, 95%CI 0.76 to 1.20), revision rates (OR 1.07, 95%CI 0.89 to 1.29), or survival (HR 2.41, 95%CI 0.78 to 7.42). Hospital stay was lower in the bariatric group (-0.16 days, 95%CI -0.23 to -0.09) as were 30-day readmissions (OR 0.17, 95%CI 0.07 to 0.40). The total costs showed no significant differences between the groups (MD 2323.06, 95%CI -3274.80 - 7920.93). Bariatric surgery may reduce the risk of periprosthetic fractures and decrease the length of hospital stay and 30-day readmission after THA. However, it did not significantly impact overall complications, including infection or revision rates.

Low Preoperative Albumin Levels Significantly Associated with Increased Risk of Wound Infection and Bleeding After Panniculectomy

Introduction: Panniculectomy is recognized to have a high complication rate with up to 56% of patients having postoperative wound healing problems. As they are generally elective procedures, surgeons have the chance to optimize preoperative variables. We reviewed the relationship between preoperative serum albumin and BMI with short-term postoperative panniculectomy complications. Methods: Patients undergoing panniculectomy between January 2005 and December 2019 were identified via CPT code 15830 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression was performed on intra/postoperative bleeding and postoperative wound infection against preoperative serum albumin, diabetes status, age, body mass index (BMI), and smoking status. Odds ratios were adjusted for comorbidities. We established statistical significance at p value <0.01. Results: Out of 1472 patients, 69 sustained intra/postoperative bleeding and 31 suffered wound infection. Lower preoperative albumin levels (R2 = 16.3%, p < 0.0001) and elevated BMI (R2 = 9.4%, p < 0.0001) were both significantly associated with increased likelihood of wound infection. For every 1 g/dL decrease in albumin, patients' odds of bleeding increased 1.85 (OR = 1.85, CI 95%= [1.14-2.99]) times, and odds of wound infection increased 5.03 (OR = 5.03, CI 95%= [2.78-9.10]) times (p < 0.0001). BMI and albumin were weakly correlated (r = -0.28) suggesting each had independent effects on complications. Conclusion: In patients undergoing panniculectomy, preoperative albumin level is significantly inversely associated with postoperative bleeding and wound complications. More research is needed to evaluate whether proactively optimizing albumin may reduce complications.

Comparison of Micronutrient Deficiencies Following Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass

INTRODUCTION

Obesity is a chronic disease that can be effectively managed with bariatric surgery, such as gastric bypass. Both Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) surgeries are associated with malnutrition. OAGB is associated with higher weight loss and remission of diabetes. However, it is also associated with a significantly greater incidence of malnutrition than RYGB. We conducted this study to assess the association of both procedures with different micronutrient deficiencies.

METHODS

A retrospective single-center cohort study was conducted. Patients undergoing RYGB and OAGB between January 1, 2022, and June 30, 2023, were included. Micronutrient deficiencies following RYGB and OAGB were compared. Vitamin B12, vitamin D, ferritin, and folate levels were assessed preoperatively and between six months to one year after the surgery.

RESULTS

A total of 116 patients underwent gastric bypass surgery, from which 50 (43.1%) patients were excluded due to loss of follow-up, and 66 (56.9%) were included. There were 50 (75.8%) RYGB cases and 16 (24.2%) OAGB cases. There were 24 (36.0%) males. The mean age was 46.2 ± 9.6 years, and the mean preoperative body weight was 131.8 ± 27.9 kg. The mean height was 165.8 ± 9.9 cm, and the mean body mass index (BMI) was 47.7 ± 7.6 kg/m2. Both groups were comparable in age, gender distribution, and height. However, patients' mean weight in the OAGB group was higher than in the RYGB group, with a correspondingly higher BMI. Folate deficiency was more common following OAGB (30.8%; N = 4) than RYGB (8.0%; N = 4) (p = 0.028). A fall in folate levels from the initial value was found in the OAGB group, while a rise was found in the RYGB group. However, the two groups had no statistically significant differences in vitamin B12, vitamin D, and ferritin deficiencies (or fall from the initial values).

CONCLUSION

Both RYGB and OAGB are associated with micronutrient deficiencies. However, OAGB is associated with an increased incidence of micronutrient deficiencies compared to RYGB after six months to one year following the surgery, especially folate deficiency (p = 0.028). Larger, prospective studies and randomized controlled trials are needed, with standardization of the BP limb, the inclusion of multiple ethnicities, and longer follow-up periods.

Assessing clinical and metabolic responses related to hyperlipidemia, MASLD and type 2 diabetes: sleeve versus RYGB

OBJECTIVE

Both Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are effective at inducing weight loss, but more information is needed on their comparative effectiveness at improving clinical/biochemical outcomes related to the presence of hyperlipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), or type 2 diabetes (T2D) at baseline. Here we aimed to assess this in real-world practice.

METHODS

This is a prospective cross-sectional and cohort study of 142 patients who underwent RYGB or LSG as per clinical practice. Clinical/biochemical data were collected at baseline, prior to surgery and 12 months post-bariatric surgery. Liver biopsy was performed during surgery to diagnose MASLD. The main outcome was 12-month changes in lipid parameters, mainly total cholesterol, between types of surgery.

RESULTS

A TOTAL OF: 107 participants underwent RYGB and 35 underwent LSG. Both groups were similar at baseline except for a higher proportion of males and waist circumference in the LSG group. At 12 months postsurgery, RYGB versus LSG resulted in a significantly lower body mass index, triglycerides, total cholesterol, and low-density lipoprotein. However, alanine aminotransferase was significantly lower in those who underwent LSG. In subgroup analyses RYGB was superior at improving lipid-related parameters in those with hyperlipidemia, whereas LSG was superior at reducing alanine aminotransferase in those with MASLD.

CONCLUSIONS

RYGB versus LSG leads to greater reductions in body mass index and lipid parameters, especially in those with hyperlipidemia, whereas LSG showed greater improvements in liver enzymes in those with MASLD.

Phytoactives for Obesity Management: Integrating Nanomedicine for Its Effective Delivery

Obesity is a global health concern that requires urgent investigation and management. While synthetic anti-obesity medications are available, they come with a high risk of side-effects and variability in their efficacy. Therefore, natural compounds are increasingly being used to treat obesity worldwide. The proposition that naturally occurring compounds, mainly polyphenols, can be effective and safer for obesity management through food and nutrient fortification is strongly supported by extensive experimental research. This review focuses on the pathogenesis of obesity while reviewing the efficacy of an array of phytoactives used for obesity treatment. It details mechanisms such as enzyme inhibition, energy expenditure, appetite suppression, adipocyte differentiation, lipid metabolism, and modulation of gut microbiota. Comprehensive in vitro, in vivo, and preclinical studies underscore the promise of phytoactives in combating obesity, which have been thoroughly reviewed. However, challenges, such as poor bioavailability and metabolism, limit their potential. Advances in nanomedicines may overcome these constraints, offering a new avenue for enhancing the efficacy of phytoactives. Nonetheless, rigorous and targeted clinical trials are essential before applying phytoactives as a primary treatment for obesity.

Obesity influencing circulating levels of nutrients: Evidence from Mendelian randomization study

Observational studies have established that obesity is associated with nutritional deficiencies, but the exact causality remains uncertain. Thus, this Mendelian randomization (MR) study aimed to identify the causal associations between obesity and circulating levels of nutrients. Single-nucleotide polymorphisms associated with obesity (body mass index and waist-hip ratio), were extracted from a genome-wide association study of 694,649 European ancestry. Summary-level data for minerals (copper, selenium, zinc, calcium, magnesium, and potassium), and vitamins (folate, vitamins A, C, E, B6, and B12), albumin were obtained from the publicly available integrative epidemiology unit OpenGWAS database psychiatric genomics consortium. Inverse-variance weighted method several sensitivity analyses were conducted. Genetically predicted higher body mass index significantly decreased circulating levels of magnesium (β = -0.07, 95% confidence interval [CI]: -0.10 to -0.03, P = 1.47 × 10-4), folate (β = -0.07, 95% CI: -0.10 to -0.04, P = 5.61 × 10-5), vitamin A (β = -0.11, 95% CI: -0.14 to -0.07, P = 3.10 × 10-9), vitamin E (β = -0.10, 95% CI: -0.13 to -0.06, P = 1.84 × 10-8), albumin (β = -0.15, 95% CI: -0.17 to -0.12, P = 9.89 × 10-28); whereas genetically predicted higher waist-hip ratio decreased circulating levels of magnesium (β = -0.07, 95% CI: -0.11 to -0.02, P = 1.87 × 10-3), folate (β = -0.07, 95% CI: -0.11 to -0.03, P = 9.87 × 10-4), vitamin C (β = -0.08, 95% CI: -0.12 to -0.04, P = 2.40 × 10-4), albumin (β = -0.08, 95% CI: -0.11 to -0.04, P = 3.72 × 10-5). The study supports a causal effect of obesity on lower circulating levels of nutrients. Our findings highlight the necessity of adjuvant nutrients in obesity management.

DXA evaluation of bone fragility 2 years after bariatric surgery in patients with obesity

Purpose

The primary objective was to evaluate bone fragility on dual X-ray absorptiometry (DXA) in patients with obesity before and 2 years after bariatric surgery. The secondary objective was to identify risk factors for the development of a bone mineral density ≤ -2 SD at 2 years.

Methods

This descriptive study included patients with obesity who underwent DXA before and 2 years (±6 months) after bariatric surgery. The BMD and the T-score were assessed at the lumbar spine, femoral neck and total hip. Data on body composition on DXA were also collected. The diagnosis of osteoporosis was retained for a T-score ≤ - 2.5 SD at any measured location. Osteopenia, or low bone mass, was defined by -2.5 SD < T-score ≤ -1 SD.

Results

Among the 675 included patients, 77.8 % were women, with a mean age of 49.5 years (±11.1). After bariatric surgery, there were significantly more patients with osteoporosis: 3.6 % vs. 0.9 % (p = 0.0001). Multivariate analysis revealed that the risk factors for developing a bone mineral density ≤ -2 SD 2 years after bariatric surgery in patients with normal BMD before surgery were age and lower lean and fat mass before the surgery (OR = 1.07, 95%CI = [1.03-1.12], OR = 0.83, 95%CI = [0.77-0.91], OR = 1.08, 95%CI = [1.02-1.15], respectively).

Conclusion

There was a significantly higher prevalence of osteoporosis and low bone mass 2 years after bariatric surgery. Older age and lower lean and fat mass at baseline were risk factors for the development of a BMD ≤ -2SD at 2 years.

Interventions to improve glycaemic control in people living with, and at risk of developing type 2 diabetes

Type 2 diabetes mellitus is one of the most prevalent health conditions worldwide, affecting millions of individuals and posing significant public health challenges. Understanding the nature of type 2 diabetes, its causes, symptoms and treatments is crucial for managing and preventing its complications. Many different dietary strategies are used by individuals to treat and manage diabetes. This review provides an overview of popular dietary strategies that have evidence for improving long-term glycaemic control or achieving diabetes remission, as well as strategies that may be useful to reduce postprandial hyperglycaemia, which may be of use in the prevention of diabetes, but also as strategies for those already diagnosed but trying to manage their condition better. Recent clinical trials have provided evidence that in people living with type 2 diabetes who also live with overweight or obesity, using a total diet replacement weight loss programme results in significant and substantial weight loss, and as a result, many people can achieve remission from their diabetes. There has been considerable interest in whether similar effects can be achieved without reliance on formula foods, using real diet approaches. Reduced or low-carbohydrate diet approaches hold some promise, with observational or preliminary findings suggesting beneficial effects, but evidence from robust trials or systematic reviews of randomized controlled trials is still lacking. The Mediterranean dietary pattern, low in saturated fat and high in monounsaturated fat, also has some potential, with evidence to suggest some people can lose weight and achieve remission using this approach, which may be easier to adhere to longer term than more intensive total diet replacement and low-carbohydrate strategies. Plant-based diets that advocate for the elimination of animal-based and/or animal-derived foods have increased in popularity. There is evidence from epidemiological studies that people who follow these diets have a lower risk of developing type 2 diabetes, and evidence from trials and systematic reviews of trials that changing to a dietary pattern lower in animal-based and animal-derived foods has benefits on glycaemic control and other markers of cardiovascular disease. While these approaches all provide food or nutrient prescriptions, approaches that incorporate periods of fasting do not provide rules on the types of foods that can or cannot be consumed, but rather provide time windows of when to eat. Evidence suggests that these approaches can be as effective in achieving energy restriction and weight loss as approaches that advocate continuous energy restriction, and there is evidence for benefits on glycaemic control independent of weight loss. Finally, popular dietary strategies that may be useful to use or combine to help prevent postprandial hyperglycaemia include reducing the glycaemic index or glycaemic load of the diet, high-fibre diets, eating foods in a meal in the order vegetables > protein > carbohydrates, preloading or combining acids such as vinegar or lemon juice with meals and engaging in low-intensity aerobic exercise immediately after meals.

Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research

AIMS

To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery.

METHODS

This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations.

RESULTS

Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems.

CONCLUSIONS

The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care.

Association between the presence of Helicobacter pylori and the development of de novo anemia in adults undergoing sleeve gastrectomy

Background

Sleeve gastrectomy has gained prominence in obesity treatment, yet it is not without complications, such as the development of anemia in the medium term. Given the high prevalence of Helicobacter pylori infection in Peru, it is imperative to explore its potential association with this postoperative complication.

Objective

To evaluate the association between the presence of Helicobacter pylori and the development of anemia 12 months after sleeve gastrectomy.

Methods

A retrospective cohort study was carried out based on an analysis of secondary data from a private clinic in Lima, Peru, which included two groups of people over 18 years of age who had undergone sleeve gastrectomy between 2010 and 2020. We considered the subjects who had the previous diagnosis of Helicobacter pylori as well as those who did not have the infection, according to the detection of the bacteria by endoscopy before surgery.

Results

A total 313 individuals were analyzed, and it was found that the prevalence of Helicobacter pylori was 46.0% and the incidence of anemia 12 months after sleeve gastrectomy was 18.2%. The presence of Helicobacter pylori increased the risk of de novo anemia (Relative Risk = 1.56; 95% confidence intervals: 1.02-2.41; p = 0.043). When stratifying by sex, the association was maintained only for the male group (Relative Risk = 2.84; 95% confidence intervals: 1.02-7.02; p = 0.047).

Conclusions

It was identified that the presence of Helicobacter pylori had a significant association with the development of de novo anemia, mainly in male subjects, 1 year after undergoing sleeve gastrectomy.

No Increased Risk of All-cause Revision up to 10 Years in Patients Who Underwent Bariatric Surgery Before Single-level Lumbar Fusion

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

This study aimed to assess whether prior bariatric surgery (BS) is associated with higher 10-year surgical complication and revision rates in lumbar spine fusion compared with the general population and morbidly obese patients.

BACKGROUND

Obesity accelerates degenerative spine processes, often necessitating lumbar fusion for functional improvement. BS is explored for weight loss in lumbar spine cases, but its impact on fusion outcomes remains unclear. Existing literature on BS before lumbar fusion yields conflicting results, with a limited investigation into long-term spine complications.

METHODS

Utilizing the PearlDiver database, we examined patients undergoing elective primary single-level lumbar fusion, categorizing them by prior BS. Propensity score matching created cohorts from (1) the general population without BS history and (2) morbidly obese patients without BS history. Using Kaplan-Meier and Cox proportional hazard modeling, we compared 10-year cumulative incidence rates and hazard ratios (HRs) for all-cause revision and specific revision indications.

RESULTS

Patients who underwent BS exhibited a higher cumulative incidence and risk of decompressive laminectomy and irrigation & debridement (I&D) within 10 years postlumbar fusion compared with matched controls from the general population [decompressive laminectomy: HR = 1.32; I&D: HR = 1.35]. Compared with matched controls from a morbidly obese population, patients who underwent BS were associated with lower rates of adjacent segment disease (HR = 0.31) and I&D (HR = 0.64). However, the risk of all-cause revision within 10 years did not increase for patients who underwent BS compared with matched or unmatched controls from the general population or morbidly obese patients (P > 0.05).

CONCLUSIONS

Prior BS did not elevate the 10-year all-cause revision risk in lumbar fusion compared with the general population or morbidly obese patients. However, patients who underwent BS were associated with a lower 10-year risk of I&D when compared with morbidly obese patients without BS. Our study indicates comparable long-term surgical complication rates between patients who underwent BS and these control groups, with an associated reduction in risk of infectious complications when compared with morbidly obese patients. Although BS may address medical comorbidities, its impact on long-term lumbar fusion revision outcomes is limited.

Pharmacotherapy as an Augmentation to Bariatric Surgery for Obesity

A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.

Malnutrition After Single Anastomosis Sleeve Ileal Bypass: A Single-Center Experience

The authors raise concerns regarding the study by Wafa et al. on the high rates of malnutrition and revisional surg