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Nutrient Intake and Deficiency of Patients 1 Year After Bariatric Surgery: Tehran Obesity Treatment Study (TOTS)

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

This study aimed at assessing nutrient adequacy after 1 year in patients who had undergone gastric bypass (GB) surgery or sleeve gastrectomy (SG) and to investigate the association of nutrient adequacy with anthropometric indices.

Methods

A total of 180 severely obese patients (BMI ≥ 35 kg/m2) were selected among the participants of Tehran Obesity Treatment Study. Nutritional assessments were performed over 3 days of 24-h dietary recall. To evaluate the nutrient adequacy ratio (NAR), the subject’s nutrient intake was divided by the dietary reference intakes. The mean adequacy ratio (MAR) was also determined as the sum of NARs divided by the number of involved nutrients (n = 11).

Results

The mean age of SG (67%) and GB (32%) patients was 39.2 ± 12 and 41.4 ± 10 years, respectively. SG patients had more postoperative fat-free mass (52.0 ± 12 kg) than GB patients (49.7 ± 8 kg) (P < 0.05). The most common postoperative serum nutrient deficiencies were related to vitamin B12 (30%), ferritin (19%), and 25-hydroxyvitamin D (16.2%). Moreover, high inadequacy of protein (> 80%) and total fat (> 70%) intake was reported. The MAR score showed that almost 45% of the patients had possibly adequate intakes of some nutrients. The adequacy of nutrients was positively associated with fat-free mass (β = 8.67, P < 0.05).

Conclusion

These findings revealed that patients had inadequate nutrient intakes 1 year after bariatric surgery, which was accompanied by serum nutritional deficiencies. Compared to GB patients, SG patients had a better body composition. Overall, compliance of patients with dietary guidelines and supplementations needs to be carefully monitored in the postoperative period.

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References

  1. Mischler RA, Armah SM, Wright BN, Mattar SG, Rosen AD, Gletsu-Miller N. Influence of diet and supplements on iron status after gastric bypass surgery. Surg Obes Relat Dis. 2016;12(3):651–8.

    Article  Google Scholar 

  2. Asghari G, Khalaj A, Ghadimi M, Mahdavi M, Farhadnejad H, Valizadeh M, et al. Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS). Obes Surg. 2018;28(8):2465–72.

    Article  Google Scholar 

  3. Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr. 2017;8(2):382–94.

    Article  Google Scholar 

  4. Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35(1):12–7.

    Article  Google Scholar 

  5. Montastier E, Chalret du Rieu M, Tuyeras G, Ritz P. Long-term nutritional follow-up post bariatric surgery. Curr Opin Clin Nutr Metab Care. 2018;21(5):388–93.

    Article  Google Scholar 

  6. Dogan K, Homan J, Aarts EO, de Boer H, van Laarhoven C, Berends FJ. Long-term nutritional status in patients following Roux-en-Y gastric bypass surgery. Clin Nutr. 2018;37(2):612–7.

    Article  Google Scholar 

  7. Al-Mutawa A, Anderson AK, Alsabah S, Al-Mutawa M. Nutritional Status of Bariatric Surgery Candidates. Nutrients. 2018;10(1).

  8. Moize V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a Mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.

    Article  Google Scholar 

  9. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    Article  CAS  Google Scholar 

  10. Barzin M, Hosseinpanah F. Bariatric Surgery for Morbid Obesity: Tehran Obesity Treatment Study (TOTS) Rationale and Study Design. 2016;5(1):e8.

  11. Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg. 2019;29(10):3385–400.

    Article  Google Scholar 

  12. Food composition table (FCT). Food and Nutrition Information Center, US Department of Agriculture 2010 [20 September 2009]. Available from: www.nal.usda.gov/fnic/foodcomp.

  13. Azar M, Sarkisian E. Food composition table of Iran: National Nutrition and Food Research Institute. Shaheed Beheshti University, Tehran. 1980.

    Google Scholar 

  14. Dietary Reference Intakes 1997-2011. Available from: www.nap.edu.

  15. Tavakoli S, Dorosty-Motlagh AR, Hoshiar-Rad A, Eshraghian MR, Sotoudeh G, Azadbakht L, et al. Is dietary diversity a proxy measurement of nutrient adequacy in Iranian elderly women? Appetite. 2016;105:468–76.

    Article  Google Scholar 

  16. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.

    Article  Google Scholar 

  17. Marcotte E, Chand B. Management and Prevention of Surgical and Nutritional Complications After Bariatric Surgery. Surg Clin North Am. 2016;96(4):843–56.

    Article  Google Scholar 

  18. Chou JJ, Lee WJ, Almalki O, Chen JC, Tsai PL, Yang SH. Dietary Intake and Weight Changes 5 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg. 2017;27(12):3240–6.

    Article  Google Scholar 

  19. Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res. 2016;118(11):1844–55.

    Article  CAS  Google Scholar 

  20. Otto M, Elrefai M, Krammer J, Weiss C, Kienle P, Hasenberg T. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Lead to Comparable Changes in Body Composition after Adjustment for Initial Body Mass Index. Obes Surg. 2016;26(3):479–85.

    Article  Google Scholar 

  21. Schneider J, Peterli R, Gass M, Slawik M, Peters T, Wolnerhanssen BK. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass lead to equal changes in body composition and energy metabolism 17 months postoperatively: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(3):563–70.

    Article  Google Scholar 

  22. Thibault R, Pichard C. Overview on nutritional issues in bariatric surgery. Curr Opin Clin Nutr Metab Care. 2016;19(6):484–90.

    Article  CAS  Google Scholar 

  23. Via MA, Mechanick JI. Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update. Curr Obes Rep. 2017;6(3):286–96.

    Article  Google Scholar 

  24. Steenackers N, Gesquiere I, Matthys C. The relevance of dietary protein after bariatric surgery: what do we know? Curr Opin Clin Nutr Metab Care. 2018;21(1):58–63.

    Article  CAS  Google Scholar 

  25. de Torres Rossi RG, Dos Santos MT, de Souza FI, de Cassia de Aquino R, Sarni RO. Nutrient intake of women 3 years after Roux-en-Y Gastric bypass surgery. Obes Surg. 2012;22(10):1548–53.

    Article  Google Scholar 

  26. Mercachita T, Santos Z, Limao J, Carolino E, Mendes L. Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of >/= 1 year. Obes Surg. 2014;24(1):102–8.

    Article  Google Scholar 

  27. Weng TC, Chang CH, Dong YH, Chang YC, Chuang LM. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5(7):e006964.

    Article  Google Scholar 

  28. Aron-Wisnewsky J, Verger EO, Bounaix C, Dao MC, Oppert JM, Bouillot JL, et al. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLoS One. 2016;11(2):e0149588.

    Article  Google Scholar 

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Acknowledgments

The authors wish to acknowledge Ms. Niloofar Shiva and NedMedica for English proofreading of the manuscript.

Funding

This study was supported by the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences (grant No.: 1784). No other source of funding was used for this study.

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Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Firoozeh Hosseini-Esfahani & Parvin Mirmiran

  2. Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran

    Alireza Khalaj

  3. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Majid Valizadeh & Maryam Barzin

  4. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

Authors
  1. Firoozeh Hosseini-Esfahani
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  2. Alireza Khalaj
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  3. Majid Valizadeh
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  4. Fereidoun Azizi
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  5. Maryam Barzin
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  6. Parvin Mirmiran
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Contributions

F.H.E. and M.B. designed the study, analyzed and interpreted the data, and drafted the manuscript. M.V., F.A., P.M., and A.K. contributed to manuscript review, critical appraisal, and specialist advice. M.B. and A.K. supervised the study. All authors reviewed and approved the final draft of the manuscript.

Corresponding author

Correspondence to Maryam Barzin.

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The authors declare that they have no conflict of interest.

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Hosseini-Esfahani, F., Khalaj, A., Valizadeh, M. et al. Nutrient Intake and Deficiency of Patients 1 Year After Bariatric Surgery: Tehran Obesity Treatment Study (TOTS). J Gastrointest Surg 25, 911–918 (2021). https://doi.org/10.1007/s11605-020-04530-9

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