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A Comparative Study Examining the Impact of a Protein-Enriched Vs Normal Protein Postoperative Diet on Body Composition and Resting Metabolic Rate in Obese Patients after Sleeve Gastrectomy

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Abstract

Background

We recently showed that an 8-week preoperative protein-enriched diet (PED) is associated with significant reductions in body weight and fat mass (FM) without significant loss of fat-free mass (FFM) in morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG).

Objectives

The objective of this study is to evaluate the impact of PED vs a normal protein diet (NPD) on total weight loss (TWL), FM, FFM, and resting metabolic rate (RMR) in patients after LSG.

Methods

Before LSG and at 3, 6, and 12 months after, we prospectively measured and compared total body weight (TBW), FM, FFM, and RMR in 60 male patients who received either a NPD (n = 30) with protein intake 1.0 g/kg of ideal body weight, or a PED (n = 30) with protein intake 2.0 g/kg of ideal body weight. Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of NPD and PED on renal function was also evaluated.

Results

Despite non-significant variation in total body weight (TBW), FM decreased more significantly (p < 0.01) with the PED compared to the NPD. In addition, the PED group showed a significantly (p < 0.01) lower decrease in FFM and RMR when compared with the NPD group. Both groups showed high compliance in following the prescribed diets, without negative impact on renal function.

Conclusion

PED is more effective than NPD in determining FM loss and is associated with a lower decrease in FFM and RMR, without interfering with renal function in male patients after LSG.

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References

  1. Johannsen DL, Knuth ND, Huizenga R, et al. Metabolic slowing with massive weight loss despite preservation of fat-free mass. J Clin Endocrinol Metab. 2012;97(7):2489–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475–82.

    CAS  PubMed  Google Scholar 

  3. Ebbeling CB, Swain JF, Feldman HA, et al. Effect of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012;307(24):2627–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ravussin E, Lillioja S, Knowler WC, et al. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988;318(8):467–72.

    Article  CAS  PubMed  Google Scholar 

  5. Mettler S, Mitchell N, Tipton KD. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc. 2010;42(2):326–37.

    Article  CAS  PubMed  Google Scholar 

  6. Pasiakos SM, Cao JJ, Margolis LM, et al. Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: a randomized controlled trial. FASEB J. 2013;27(9):3837–47.

    Article  CAS  PubMed  Google Scholar 

  7. Sherman V, Brethaer SA, Chand B, et al. Laparoscopic sleeve gastrectomy. In: Schauer PR, Schirmer BD, Brethaer SA, editors. Minimally invasive bariatric surgery. New York: Springer Inc; 2007. p. 173–9.

    Chapter  Google Scholar 

  8. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Clin Nutr. 2015 Oct;25(10):1822–32.

    CAS  Google Scholar 

  9. Gentileschi P. Laparoscopic sleeve gastrectomy as a primary operation for morbid obesity: experience with 200 patients. Gastroenterol Res Pract. 2012;2012:801325.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.

    Article  CAS  PubMed  Google Scholar 

  11. Abu-Jaish W, Rosenthal RJ. Sleeve gastrectomy: a new surgical approach for morbid obesity. Expert Rev Gastroenterol Hepatol. 2010;4(1):101–19.

    Article  PubMed  Google Scholar 

  12. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  13. Committee AHSSAHN, Aills L, Blankenship J, et al. Allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108.

    Google Scholar 

  14. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by America Association of Clinical Endocrinologists, The Obesity Surgery, and The American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl 1):S1–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes. 2007;31(5):743–50.

    CAS  Google Scholar 

  16. Wells J, Miller M, Perry B, et al. Preservation of fat-free mass after bariatric surgery: a comparison of malabsorptive and restrictive procedures. Am Surg. 2015;81(8):812–5.

    PubMed  Google Scholar 

  17. Belfiore A, Cataldi M, Minichini L, et al. Short-term changes in body composition and response to micronutrient supplementation after laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(12):2344–51.

    Article  CAS  PubMed  Google Scholar 

  18. Schiavo L, Scalera G, Sergio R, et al. Clinical impact of Mediterranean enriched-protein diet on liver size, visceral fat, fat mass, and fat-free mass in patients undergoing sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(5):1164–70.

    Article  PubMed  Google Scholar 

  19. Fried M, Yumuk V, Oppert JM, et al. International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC); European Association for the Study of Obesity (EASO); European Association for the Study of Obesity Obesity Management Task Force (EASO OMTF). Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014 Jan;24(1):42–55.

    Article  CAS  PubMed  Google Scholar 

  20. Schiavo L, Scalera G, Pilone V, et al. Micronutrient deficiencies in patients candidate for bariatric surgery: a prospective, preoperative trial of screening, diagnosis, and treatment. Int J Vitam Nutr Res. 2016 May 10:1–8. doi:10.1024/0300-9831/a000282.

  21. Haugen HA, Chan LN, Li F. Indirect calorimetry: a practical guide for clinicians. Nutr Clin Pract. 2007;22(4):377–88.

    Article  PubMed  Google Scholar 

  22. Nieman DC, Austin MD, Benezra L, et al. Validation of Cosmed’s FitMate in measuring oxygen consumption and estimating resting metabolic rate. Res Sports Med. 2006;14(2):89–96.

    Article  PubMed  Google Scholar 

  23. Haugen HA, Melanson EL, Tran ZV, et al. Variability of measured resting metabolic rate. Am J Clin Nutr. 2003;78(6):1141–5.

    CAS  PubMed  Google Scholar 

  24. Compher C, Frankenfield D, Keim N, et al. Evidence analysis working group. Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006;106(6):881–903.

    Article  PubMed  Google Scholar 

  25. Schröder H, Covas MI, Marrugat J, et al. Use of a three-day estimated food record, a 72-h recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population. Clin Nutr. 2001 Oct;20(5):429–37.

    Article  PubMed  Google Scholar 

  26. Schollenberger AE, Karschin J, Meile T, et al. Impact of protein supplementation after bariatric surgery: a randomized controlled double-blind pilot study. Nutrition. 2016;32(2):186–92.

    Article  CAS  PubMed  Google Scholar 

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

  28. Deurenberg P. Limitation of the bioelectrical impedance method for the assessment of body fat in severe obesity. Am J Clin Nutr. 1996;64(3 Suppl):449S–52S.

    CAS  PubMed  Google Scholar 

  29. Leal AA, Faintuch J, Morais AA, et al. Bioimpedance analysis: should be used in morbid obesity? Am J Hum Biol. 2011;23(3):420–2.

    Article  PubMed  Google Scholar 

  30. Das SK, Roberts SB, Kehayias JJ, et al. Body composition assessment in extreme obesity and after massive weight loss induced by gastric bypass surgery. Am J Physiol Endocrinol Metab. 2003;284(6):1080–8.

    Article  Google Scholar 

  31. Faria SL, Faria OP, Cardeal MD, et al. Validation study of multi-frequency bioelectrical impedance with dual-energy X-ray absorptiometry among obese patients. Obes Surg. 2014;24(9):1476–80.

    Article  PubMed  Google Scholar 

  32. Ballesteros-Pomar MD, Calleja-Fernández A, Diez-Rodríguez R, et al. Comparison of different body composition measurements in severely obese patients in the clinical setting. Nutr Hosp. 2012;27(5):1626–30.

    CAS  PubMed  Google Scholar 

  33. Roubenoff R. The pathophysiology of wasting in the elderly. J Nutr. 1999;129(1S Suppl):256S–9S.

    CAS  PubMed  Google Scholar 

  34. Wang Z, St-Onge MP, Lecumberri B, et al. Body cell mass: model development and validation at the cellular level of body composition. Am J Physiol Endocrinol Metab. 2004;286(1):E123–8.

    Article  CAS  PubMed  Google Scholar 

  35. Mialich MS, Sicchieri JM, Jordao AA. Analysis of body composition: a critical review of the use of bioelectrical impedance analysis. Int J Clin Nutr. 2014;2(1):1–10.

    Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Surgery and Emergency Science, Second University of Naples, Naples, Italy

    Luigi Schiavo, Giuseppe Scalera, Gabriele De Sena, Vincenzo Quagliariello & Alfonso Barbarisi

  2. Department of Medicine and Surgery, University of Salerno, Salerno, Italy

    Vincenzo Pilone

  3. Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France

    Antonio Iannelli

  4. Inserm, U1065, Team 8 “Hepatic complications of obesity”, 06204, Nice, France

    Antonio Iannelli

  5. University of Nice Sophia-Antipolis, 06107, Nice, France

    Antonio Iannelli

Authors
  1. Luigi Schiavo
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  2. Giuseppe Scalera
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  3. Vincenzo Pilone
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  4. Gabriele De Sena
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  5. Vincenzo Quagliariello
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  6. Antonio Iannelli
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  7. Alfonso Barbarisi
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Corresponding author

Correspondence to Luigi Schiavo.

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Conflict of Interest

The authors declare no conflicts of interest.

Informed Consent

Written informed consent was obtained for each individual participant included in the study.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments. Research Registry Identifier Number 1566.

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Schiavo, L., Scalera, G., Pilone, V. et al. A Comparative Study Examining the Impact of a Protein-Enriched Vs Normal Protein Postoperative Diet on Body Composition and Resting Metabolic Rate in Obese Patients after Sleeve Gastrectomy. OBES SURG 27, 881–888 (2017). https://doi.org/10.1007/s11695-016-2382-y

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  • DOI: https://doi.org/10.1007/s11695-016-2382-y

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