Abstract
Objective
To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery.
Methods
Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined.
Results
Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume > 3 L compared to those with < 3 L (adjusted P value < 0.001). The percentages of total weight lost were 5.8 and 4.2% (adjusted P value = 0.004) for participants on the VLCD and LCD, respectively. There were no differences between groups for any of the biochemical parameters analyzed, nor in the number of surgical complications nor the length of hospital stay. Adherence to the diet was good; nevertheless, participants in the VLCD intervention showed worse tolerance.
Conclusions
In subjects with morbid obesity undergoing bariatric surgery, compared to a LCD, a preoperative 21-day intervention with VLCD is more effective in terms of reducing total body weight but not in terms of reducing the liver volume. Both types of preoperative diets have similar effects on clinical biochemical parameters, rate of surgical complications, and hospital length stay.
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References
World Health Organization (WHO) –NCD RisC. (NCD RiSk Factor Collaboration). [Internet]. 2017. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
Attar BM, Van Thiel DH. Current concepts and management approaches in nonalcoholic fatty liver disease. Sci World J [Internet]. 2013;2013. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2013259483
Sasaki A, Nitta H, Otsuka K, Umemura A, Baba S, Obuchi T, et al. Bariatric surgery and non-alcoholic fatty liver disease: Current and potential future treatments. Front Endocrinol (Lausanne). 2014;5(OCT):1–6.
Sjöström CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res. 1999;7:477–84.
Edholm D, Kullberg J, Karlsson FA, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis. 2015;11(3):602–6. Available from:. https://doi.org/10.1016/j.soard.2014.07.018.
van Wissen J, Bakker N, Doodeman HJ, et al. Preoperative methods to reduce liver volume in bariatric surgery: a systematic review. Obes Surg. 2016;26(2):251–6.
Van-Nieuwenhove Y. Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass. A Randomized Multicenter Study. Arch Surg. 2011;146(11):1300. Available from: http://archsurg.jamanetwork.com/article.aspx?articleid=1107206#METHODS%5Cn. http://www.ncbi.nlm.nih.gov/pubmed/22106323%5Cnhttp://archsurg.jamanetwork.com/article.aspx?articleid=1107206
Kim JJ, Rogers AM, Ballem N, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955–9. Available from:. https://doi.org/10.1016/j.soard.2016.04.019.
Lewis M, Phillips M, Slavotinek J, et al. Change in liver size and fat content after treatment with Optifast ® very low calorie diet. Obes Surg. 2006;16(6):697–701.
Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7(4):480–5. Available from:. https://doi.org/10.1016/j.soard.2010.09.026.
Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16895876
González-Pérez J, Sánchez-Leenheer S, Delgado AR, et al. Clinical impact of a 6-week preoperative very low calorie diet on body weight and liver size in morbidly obese patients. Obes Surg. 2013;23(10):1624–31.
Faria SL, Faria OP, de Cardeal MA, et al. Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial. Surg Obes Relat Dis. 2015;11(1):230–7. Available from: http://www.sciencedirect.com/science/article/pii/S1550728914002573
Alabdali F, Rueda-Clausen CF, Robbins S, et al. Efficacy and safety of long-term low-calorie diet in severely obese patients non-eligible for surgery. Clin Obes. 2013;3(3–4):90–4.
Benjaminov O, Beglaibter N, Gindy L, et al. The effect of a low-carbohydrate diet on the nonalcoholic fatty liver in morbidly obese patients before bariatric surgery. Surg Endosc Other Interv Tech. 2007;21(8):1423–7.
Pekkarinen T. Use of very low-calorie diet in preoperative weight loss: efficacy and safety. Obes Res. 1997;5(6):595–602.
Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25(6):939–48.
Schouten R, van der Kaaden I. Van ‘t Hof G, Feskens PGBM. Comparison of preoperative diets before bariatric surgery: a randomized, single-blinded, non-inferiority trial. Obes Surg. 2016;26(8):1743–9.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Author 9 reports receiving a grant from Nestle thorough his Institution. The rest of authors declare that they have no conflict of interest.
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Informed consent was obtained from all individual participants included in the study.
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Gils Contreras, A., Bonada Sanjaume, A., Montero Jaime, M. et al. Effects of Two Preoperatory Weight Loss Diets on Hepatic Volume, Metabolic Parameters, and Surgical Complications in Morbid Obese Bariatric Surgery Candidates: a Randomized Clinical Trial. OBES SURG 28, 3756–3768 (2018). https://doi.org/10.1007/s11695-018-3413-7
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DOI: https://doi.org/10.1007/s11695-018-3413-7