Bariatric surgery, a highly successful treatment for obesity, requires adherence to special dietary recommendations to insure the achievement of weight loss goals and weight maintenance. Postoperative consumption of protein is linked to satiety induction, nutritional status, and weight loss. Hence, we conducted an extensive literature review to identify studies focused on the following: protein and nutritional status; recommendations for dietary protein intake; the effects of protein-rich diets; and associations between dietary protein intake and satiety, weight loss, and body composition. We found that there have been few studies on protein intake recommendations for bariatric patients. Dietary protein ingestion among this population tends to be inadequate, potentially leading to a loss of lean body mass, reduced metabolic rates, and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhanced weight loss, and improved body composition. The quality and composition of protein sources are also very important, particularly with respect to the quantity of leucine, which helps to maintain muscle mass, and thus is particularly important for this patient group. Randomized studies among bariatric surgery patient populations are necessary to establish the exact quantity of protein that should be prescribed to maintain their nutritional status.
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Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes (Lond). 2009;33(5):577–82.
World Health Organization. http://www.who.int/en/. Accessed July 2010.
Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30 (Editorial).
Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. Am J Med Assoc. 1999;282:1523–9.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Marcason W. What are the dietary guidelines following bariatric surgery? Am J Diet Assoc. 2004;104(3):487–8.
Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.
Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.
Westerterp-Platenga MS, Nieuwenhuizen A, Tomé D, et al. Dietery protein, weight loss, and weight maintenance. Ann Rev Nutr. 2009;29:21–41.
Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13:21–8.
Famsworth E, Luscombe ND, Noakes M, et al. Effect of a high protein, energy-restricted diet on body composition, glycemic control, and lipid concentration in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr. 2003;78:31–9.
Faria SL, de Oliveira Kelly E, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20:135–9.
Shai I, Schwarzfuchs D, Henkin Y. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229–41.
Aills L, Blankenship J, Buffington C, et al. ASMBS Allied Health Nutritional Guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4:S73–108.
Jackson AA, Gibson NR, Lu Y, et al. Synthesis of erythrocyte glutathione in healthy adults consuming the safe amount of dietary protein. Am J Clin Nutr. 2004;80:101–7.
Castellanos VH, Litchford MD, Campbell WW. Modular protein supplements and their application to long-term care. Nutr Clin Pract. 2006;21:485–504.
Humayun MA, Elango R, Ball RO, et al. Reevaluation of the protein requirement in young men with the indicator amino acid oxidation technique. Am J Clin Nutr. 2007;85:995–1002.
Layman DK, Boileau RD, Erickson DJ, et al. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr. 2003;133:411–7.
Schinkel ER, Pettine SF, Adams E, et al. Impact of varying levels of protein intake on protein status indicators after gastric bypass in patients with multiple complications requiring nutritional support. Obes Surg. 2006;16:24–30.
Layman DK, Shiue H, Sather C, et al. Increased dietary protein modifies glucose and insulin homeostasis in adult women during weight loss. J Nutr. 2003;133:405–10.
Layman DK, Evans E, Baum JI, et al. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr. 2005;135:1903–10.
Volek JS, Sharman MJ. Cardiovascular and hormonal aspects of very-low-carbohydrate ketogenic diets. Obes Res. 2004;12:115S–23.
Bock MA. Roux-en-Y gastric bypass: the dietitian’s and patient’s perspectives. Nutr Clin Pract. 2003;18:141–4.
Faria SL, Faria OP, Lopes TC, et al. Relation between carbohydrate intake and weight loss after bariatric surgery. Obes Surg. 2008;19(6):708–16.
Andreu A, Moize A, Rodríguez L, et al. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg. 2010;20:1509–15.
Ritz P, Becouarn G, Douay O. Gastric bypass is not associated with protein malnutrition in morbidly obese patients. Obes Surg. 2009;19:840–4.
Delegge MH, Drake LM. Nutritional assessment. Gastroenterol. 2007;36:1–22. EX 25.
Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci. 1994;39(2):315–20.
Faria SL, Kelly EO, Faria OP, et al. Snack-eating patients experience lesser weight loss after Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19(9):1293–6.
DRI. Institute of Medicine, Food and Nutrition Board, Dietary Reference Intakes: energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Washington: The National Academy; 2005.
Elango R, Humayun MA, Ball RO, et al. Evidence that protein requirements have been significantly underestimated. Curr Opin Clin Nutr Metab Care. 2010;13:52–7.
Afolabi PR, Jahoor F, Gibson NR, et al. Response of hepatic proteins to the lowering of habitual dietary protein to the recommended safe level of intake. Am J Physiol. 2004;287:E327–30.
Young VR, Taylor YS, Rand WM, et al. Protein requirements of man: efficiency of egg protein utilization at maintenance and submaintenance levels in young men. J Nutr. 1973;103:1164–74.
Rand WM, Young VR. Statistical analysis of nitrogen balance date with reference to the lysine requirements in adults. J Nutr. 1999;129:1920–6.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.
NIH. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res. 1998;6(suppl):51S–209S.
Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q. 2003;26(2):133–8.
Smeets AJ, Soenen S, Luscombe-Marsh ND, et al. Energy expenditure, satiety, and plasma ghrelin, glucagon-like peptide 1, and peptide tyrosine–tyrosine concentrations following single high protein lunch. J Nutr. 2008;138:698–702.
Bellissimo N, Desantadina MV, Pencharz PB, et al. A comparison of short-term appetite and energy intakes in normal weight and obese boys following glucose and whey-protein drinks. Int J Obes (Lond). 2008;32:362–71.
Diepvens K, Haberer D, Westerterp-Platenga MS. Different proteins and biopeptides differently affect satiety and anorexigenic/orexigenic hormones in healthy humans. Int J Obes. 2008;32:10–8.
Leibowitz SF, Alexander JT. Hypothalamic serotonin in control of eating behavior, meal size, and body weight. Bio Psychiatry. 1998;44(9):851–64.
Wurtman RJ, Wurtmam JJ. Do carbohydrates affect food intakes via neurotransmitter activity? Appet. 1998;11:42–7.
Goto K, Kasaoka S, Takizawa M, et al. Bitter taste and blood glucose are not involved in the suppressive effect of dietary histidine on food intake. Neurosci Lett. 2007;420(2):106–9.
Hall WL, Millward DJ, Long SJ, et al. Casein and whey exert different effects on plasma amino acids profiles, gastrointestinal hormone secretion and appetite. Br J Nutr. 2003;89:239–48.
Meier JJ, Nauck MA. Glucagon-like peptide 1 (GLP-1) in biology and pathology. Diab Metab Res Rev. 2005;21:91–117.
Verdich C, Flint A, Gutzwiller JP. A meta-analysis of the effect of glucagon-like peptide-1 (7–36) amide on ad libitum energy intake in humans. J Clin Endocrinol Metab. 2001;86:4382–9.
Batterham RL, Cohen MA, Ellis SM, et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med. 2003;349:941–8.
Batterham RL, Heffron H, Kapoor S, et al. Critical role for peptide YY in protein-mediated satiation and body-weight regulation. Cell Metab. 2006;4:223–33.
Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes. 2007;31:743–50.
Faria S, Faria O, Furtado M, et al. Analysis of body composition 629 evolution after Roux-en-Y gastric bypass [abstract]. Obes Surg. IFSO. 2010;630:98–99.
Layman DK, Walker DA. Potential importance of leucine in treatment of obesity and the metabolic syndrome. J Nutr. 2006;136:319S–23.
Parker B, Noakes M, Luscombe N, et al. Effect of a high protein, high monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Am Diab Ass. 2002;25:425–30.
Piatti PM, Monti LD, Magni F, et al. Hypocaloric high-protein diet improves glucose oxidation and spares lean body mass: comparison to hypocaloric high carbohydrate diet. Metab. 1994;43:1481–7.
Skov AR, Toubro S, Ronn B, et al. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes. 1999;23:528–36.
Due A, Toubro S, Skov AR, et al. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes. 2004;28:1283–90.
Weigle DS, Breen PA, Matthys CC, et al. A high protein diet induces sustained reductions in appetite, ad libitum calorie intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 2005;82:41–8.
Margriet S, Westerterp-Platenga MS. The significance of protein in food intake and body weight regulation. Opin Clin Nutr Metab Care. 2003;6:635–8.
Dumesnil JG, Turgeon J, Tremblay A. Effect of a low-glycaemic index–low-fat–high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr. 2001;86:557–68.
Westerterp KR, Wilson SAJ, Rolland A. Diet-induced thermogenesis measured over 24 h in a respiration chamber: effect of diet composition. Int J Obes. 1999;23:287–92.
Feinman RD, Fine EJ. Thermodynamics and metabolic advantage of weight loss diets. Metab Syn Relat Dis. 2003;1:209–19.
Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–40.
Layman DK. The role of leucine in weight loss diets and glucose homeostasis. J Nutr. 2003;133:261S–7.
Kimball SR, Jefferson LS. Regulation of protein synthesis by branched-chain amino acids. Curr Opin Clin Nutr Metab Care. 2001;4:39–43.
Phillips SM. Protein requirements and supplementation in strength sports. Nutrition. 2004;20:689–95.
Millward DJ, Layman DK, Tomé D, et al. Protein quality assessment: impact of expanding understanding of protein and amino acid needs for optimal health. Am J Clin Nutr. 2008;87(suppl):1576S–81.
FAO/WHO/UNU: Energy and protein requirements. Report of a joint FAO/WHO/UNU expert consultation. WHO tech Pep Ser. 1985;724:1–206.
Layman DK. Protein quantity and quality at levels above RDA improves adult weight loss. J Am Coll Nutr. 2004;23(6):631S.
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Faria, S.L., Faria, O.P., Buffington, C. et al. Dietary Protein Intake and Bariatric Surgery Patients: A Review. OBES SURG 21, 1798–1805 (2011). https://doi.org/10.1007/s11695-011-0441-y
- Weight loss
- Bariatric surgery
- Body composition