Resolution of diabetes, gastrointestinal symptoms, and self-reported dietary intake after gastric bypass vs sleeve gastrectomy – a randomized study

BACKGROUND

There is a lack of randomized studies examining diabetes remission and dietary intake between patients undergoing Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG).

OBJECTIVE

To examine longitudinal differences in diabetes resolution, dietary intake, and gastrointestinal (GI) symptoms in patients with obesity and type 2 diabetes (T2D) randomized to either RYGB or SG and according to remission of T2D.

SETTING

Four hospitals in Sweden, 2 of which are university hospitals.

METHODS

Dietary intake and GI symptoms were calculated from questionnaires and morphometric differences between surgical methods and T2D remission were compared using the Student t test, effect size (ES) for parametric parameters, and Mann-Whitney U test for nonparametric parameters.

RESULTS

Five years after RYGB or SG there was no significant difference in the rate of remission of T2D between RYGB and SG (43% versus 20%, P = .176). RYGB (n = 19) patients had greater weight loss than SG patients (n = 14) (26.4 [9.5] versus 13.1 [9.6] kg, P < .001), despite reporting higher daily caloric intake (Δ 669 kcal, P = .059, ES .67) and food weight (Δ 1029 g/d, P = .003, ES 1.11). RYGB patients, compared with SG patients, also ate 1 more fruit per day (P = .023). Pooled data showed no differences between patients with and without T2D remission regarding weight loss, but those in remission drank more nonalcoholic drinks and milk.

CONCLUSIONS

Five years postoperatively, patients randomized to RYGB reported considerably higher food intake compared with SG despite lower body weight. The reason and importance of the higher food intake after RYGB compared with SG needs to be further studied.

Comparison of the 2010 and 2019 diagnostic criteria for sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) in two cohorts of Swedish older adults

Background

The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores.

Methods

Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model.

Results

Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P <  0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P <  0.001) in the 70-year-olds and 17.8% (P <  0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P <  0.05) but not at T-score − 2.0.

Conclusions

The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02533-y.

Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis

BACKGROUND

Cancer-associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C-reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer-associated WL (primary endpoint) and overall survival (OS, secondary endpoint).

METHODS

The data set included a total of 12,253 patients at risk for cancer-associated WL. Patient-reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively.

RESULTS

Patients had a mean weight change of -7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5-5.9% (19.7%), 6.0-10.0% (23.2%), 11.0-14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P < 0.0001) if food intake was moderately [OR 6.28, 95% confidence interval (CI 5.28-7.47)] or severely reduced [OR 18.98 (95% CI 15.30-23.56)]. In subset analysis, adjusted for food intake, CRP was independently associated (P < 0.0001) with ≥15% WL [CRP 10-100 mg/L: OR 2.00, (95% CI 1.58-2.53)] and [CRP > 100 mg/L: OR 2.30 (95% CI 1.62-3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5-10.3), with median follow-up of 39.7 months (95% CI 38.8-40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P < 0.0001).

CONCLUSIONS

Modelling WL as the dependent variable is an approach that can help to identify clinical features and biomarkers associated with WL. Here, we identify criterion values for food intake impairment and CRP that may improve the diagnosis and classification of cancer-associated cachexia.

Dietary intake and nutritional status in adolescents and young adults with anorexia nervosa: A 3-year follow-up study

BACKGROUND & AIMS

Patients with anorexia nervosa (AN) restrict their dietary intake leading to malnutrition. Information is scarce on nutrition status during recovery. The aim of the study was to investigate dietary intake, body composition, biochemistry, and status in young women three years after hospital treatment due to severe restrictive AN.

METHODS

Dietary intake from four-day food records were compared to a reference group and the Nordic Nutrition Recommendations. Body composition was assessed by dual-energy X-ray absorptiometry (DXA). Serum levels of vitamin A, E, D, folate, and ferritin were assessed.

RESULTS

Three years after hospital treatment for AN, 12 subjects (60%) were recovered or in partial remission from AN. Subnormal values of body fat and skeletal muscle mass were present in 30% and 25%. Energy intake was 1730 kcal/day (min-max 705-2441) or 33 kcal/kg/day (16-54). Most (80%) had a total energy intake/day below the estimated needs and 6 (32%) had energy intakes below 1550 kcal/day. Micronutrient intakes from food were low; 16 (85%) had intakes below recommendations of iron, folate, and vitamin D. Serum levels of vitamins A, E, D, and folate were on average adequate; but a subnormal value (<50 nmol/L) of vitamin D was found in 20%. Ferritin levels were significantly lower at follow-up, and 25% had values below reference range. Return of menstruation was dependent of energy intake and body fat.

CONCLUSIONS

A regular and careful assessment of nutritional status along with nutritional counseling during recovery is recommended to reduce malnutrition in patients with AN.

A Western-style dietary pattern is associated with cerebrospinal fluid biomarker levels for preclinical Alzheimer's disease-A population-based cross-sectional study among 70-year-olds

BACKGROUND

Diet may be a modifiable factor for reducing the risk of Alzheimer's disease (AD). Western-style dietary patterns are considered to increase the risk, whereas Mediterranean-style dietary patterns are considered to reduce the risk. An association between diet and AD-related biomarkers have been suggested, but studies are limited.

AIM

To investigate potential relations between dietary patterns and cerebrospinal fluid (CSF) biomarkers for AD among dementia-free older adults.

METHODS

Data were derived from the population-based Gothenburg H70 Birth Cohort Studies, Sweden. A total of 269 dementia-free 70-year-olds with dietary and cerebrospinal fluid (CSF) amyloid beta (Aβ42 and Aβ40), total tau (t-tau), and phosphorylated tau (p-tau) data were investigated. Dietary intake was determined by the diet history method, and four dietary patterns were derived by principal component analysis. A Western dietary pattern, a Mediterranean/prudent dietary pattern, a high-protein and alcohol pattern, and a high-total and saturated fat pattern. Logistic regression models, with CSF biomarker pathology (yes/no) as dependent variables, and linear regression models with continuous CSF biomarker levels as dependent variables were performed. The analyses were adjusted for sex, energy intake, body mass index (BMI), educational level, and physical activity level.

RESULTS

The odds ratio for having total tau pathology (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.02 to 2.01) and preclinical AD (Aβ42 and tau pathology; OR 1.79; 95% CI 1.03 to 3.10) was higher among those with a higher adherence to a Western dietary pattern. There were no other associations between the dietary patterns and CSF biomarkers that remained significant in both unadjusted and adjusted models.

DISCUSSION

Our findings suggest that higher adherence to a Western dietary pattern may be associated with pathological levels of AD biomarkers in the preclinical phase of AD. These findings can be added to the increasing amount of evidence linking diet with AD and may be useful for future intervention studies investigating dietary intake in relation to AD.

Nocturnal eating but not binge eating disorder is related to less 12 months' weight loss in men and women with severe obesity: A retrospective cohort study

There is a paucity of studies on the frequency of binge-eating disorder (BED) and nocturnal eating (NE) and their potential role as barriers in non-surgical weight loss treatment in subjects with severe obesity (body mass index [BMI] ≥35 kg m² ). The aim was to identify BED and NE, and their effect on weight loss treatment. In total, 1132 (727 women, 405 men), BMI ~41 kg/m² were patients in a 12-month weight loss programme at a specialist clinic. The questionnaire for eating and weight patterns-revised was completed by the patients before start of treatment. BED was diagnosed in 5.1% of men and 12.4% of women. NE prevalence was 13.5% and 12.7%, respectively. Mean (±SEM) 12-month weight loss was less in patients with NE compared to those without (-11.0 ± 1.5 vs -14.6 ± 0.7 kg, P = .008) but did not differ in patients with and without BED, (-12.3 ± 1.9 vs -14.2 ± 0.6 kg, P = .24). Factors associated with dropout were BED (odds ratio, OR 1.57, 95% confidence interval (CI) 1.14-2.17; P = .006) and previous weight loss attempts (OR 1.35, 95% CI 1.0-1.7; P = .02). BED did not seem to hinder weight loss whereas NE resulted in less weight loss in patients with severe obesity who completed a 12-month treatment programme. Previous weight loss attempts affect both dropout and ability to lose weight.

Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies.

OBJECTIVES

To assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB.

SETTING

University hospitals, multicenter study, Sweden.

METHODS

Micronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (± 1.2) with a body mass index of 45.5 kg/m² (± 6.0). Adherence was defined as taking prescribed supplements ≥3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years.

RESULTS

Over 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44-61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P < .04) and 61% had iron deficiency (P ≤ .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P < .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B₁₂, and ferritin (females) compared with both adhering adolescents and the control group (all P < .04).

CONCLUSIONS

Half of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies.

Determinants of change in resting energy expenditure in patients with stage III/IV colorectal cancer

BACKGROUND & AIMS

Resting energy expenditure (REE) is variable in cancer and might be influenced by changes in tumor burden, systemic inflammation, and body composition. The objective of this study was to assess REE change and the predictors of such in patients with stage III or IV colorectal cancer.

METHODS

REE was measured via indirect calorimetry and fat mass and fat-free mass (FFM) were assessed using dual X-ray absorptiometry as part of a unique analysis of two studies. C-reactive protein (CRP) was measured as an inflammatory marker. Linear regression was used to assess the determinants of REE at baseline and REE change, with days between baseline and follow-up measures included as a covariate.

RESULTS

One-hundred and nine patients were included at baseline (59.6% male; 67 ± 12 years; body mass index 24.1 ± 4.3 kg/m²); 49 had follow-up data (61.2% male; 65 ± 12 years; body mass index 25.4 ± 4.3 kg/m²), with median follow-up of 119 days (interquartile range: 113-127 days). At baseline, age, FFM, and CRP explained 68.9% of the variability in REE. A wide variability in REE change over time was observed, ranging from -156 to 370 kcal/day, or -13.0 to 15.7%/100 days. CRP change (1.7 ± 0.4 mg/L, p < 0.001) and stage (81.3 ± 38.7, p = 0.042) predicted REE change in multivariate analysis, controlling for age, FFM change, and days between visits (R²: 0.417 ± 88.2, p < 0.001).

CONCLUSIONS

Age, FFM, and CRP predicted REE at a single time point. REE change was highly variable and explained by inflammation and stage. Future research should investigate the validity and feasibility of incorporating these measures into energy needs recommendations.

Five-year changes in dietary intake and body composition in adolescents with severe obesity undergoing laparoscopic Roux-en-Y gastric bypass surgery

BACKGROUND

Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB).

OBJECTIVES

To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB.

SETTING

University hospitals, multicenter study, Sweden.

METHODS

Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m²) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years.

RESULTS

Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P = .03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P = .003).

CONCLUSIONS

In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass.

Loss of muscle mass in the end of life in patients with advanced cancer

PURPOSE

Muscle mass depletion is associated with adverse outcomes in cancer patients. There is limited information on the impact of age, sex, tumor type, and inflammation on muscle loss in the end of life of cancer patients.

METHODS

Muscle depletion and loss of muscle in the last 2 years of life was estimated in 471 cancer patients from 779 dual-energy X-ray absorptiometry scans. A linear mixed model was used to estimate the impact of age, sex, tumor type, and inflammation.

RESULTS

Patients above median age (>71 years) had less muscle mass (-1.1 ± 0.3 kg, P < 0.001). Prevalence of muscle depletion was higher in men than women (59 vs. 28%, P < 0.001). Men lost muscle mass over time (mean, 1.4 ± 0.3 kg/year, P < 0.001) contrary to women (0.3 ± 0.4 kg/year, P = 0.5). Patients with pancreatic cancer had less muscle mass than patients with biliary tract and colorectal cancers (P < 0.02). There were no differences in muscle loss over time in patients grouped by median age or tumor type. The prevalence of elevated C-reactive protein was 61 to 70% during the study. Patients with C-reactive protein >10 mg/L had less muscle mass (0.6 ± 0.2 kg, P < 0.001) and lost muscle mass at an accelerated pace during the disease trajectory (0.7 ± 0.3 kg/year, P = 0.03).

CONCLUSIONS

Muscle loss in advanced cancer is related to age, sex, tumor type, and inflammation. The mechanism(s) behind the apparent sexual dimorphism warrants further study.

Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study

BACKGROUND & AIMS

The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity.

METHODS

One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life.

RESULTS

Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively.

CONCLUSION

After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.

Diet energy density and energy intake in palliative care cancer patients

BACKGROUND & AIMS

Anorexia and cachexia are frequent in advanced cancer. Energy density may be important in the control of energy intake; however, current data are derived from studies in healthy or obese populations and there is no agreed definition and methods of calculation. We studied energy density and energy intake in a group of palliative cancer patients and explored which method of energy density calculation that yielded the highest determination coefficient of energy intake.

METHODS

Energy density was calculated from 259 food records using four methods, differing in the types of food and beverages included in the analysis. Association between energy density and energy intake was tested using regression analysis.

RESULTS

The determination coefficient for total energy intake was: 0.181, 0.148, 0.222, and 0.211 for methods 1-4, respectively (P for all <0.001). In relation to energy per kg body weight and resting energy expenditure, methods 3 and 1 yielded the highest determination coefficient, R2 = 0.164 and 0.184, respectively.

CONCLUSIONS

We found a positive association between diet energy density and energy intake. The method used when calculating energy density had limited impact on this association. When calculating energy density all food and beverages should be included in the analysis.