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Four Weeks of Preoperative Omega-3 Fatty Acids Reduce Liver Volume: a Randomised Controlled Trial

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Abstract

Purpose

Weight loss before bariatric surgery with a low-calorie diet (LCD) has several advantages, including reduction of liver volume and an improved access to the lesser sac. Disadvantages include performing surgery in a state of undernutrition, side effects, costs and patient compliance. Omega-3 fatty acids may serve as an alternative to reduce liver steatosis.

Materials and Methods

A randomised controlled open-label trial was done to compare the effects of a LCD with Modifast (800 kcal/day) during 2 weeks with 2 g of omega-3 fatty acids a day and a normal diet (2000 kcal/day) during 4 weeks. Total liver volume (TLV) and volume of the left liver lobe (LLL), visceral fat area (VFA) and muscle area (SMA) at the L3–L4 level were measured with MRI before and after preoperative treatment.

Results

Sixty-two morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) were recruited. In both groups, there was a significant decrease in LLL, TLV and VFA. For LLL and TLV reduction, the LCD had a significantly larger effect (p < 0.05). Only in the LCD group was there a significant decrease in SMA with significantly more side effects and worse compliance.

Conclusion

Both the LCD and omega-3 diet reduced LLL, TLV and VFA. The LCD outperformed the omega-3 diet in LLL and TLV reduction, but induced significant loss of SMA and had worse compliance due to more side effects. Omega-3 fatty acids may provide a safe and more patient-friendly alternative for a LCD and further research is indicated.

Trial Registration

The study is registered at www.clinicaltrials.gov (NCT02206256).

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Acknowledgments

We thank all of the patients for their participation in this study. We thank the staff of the Dutch Obesity Clinic for their help with recruiting patients. We thank the staff of the Radiology Department for their assistance with the MRI scans. We thank the staff of the Red Cross Hospital Laboratory, Outpatient Clinic and Operation Room for their help with the practical aspects of the study. We thank H.J. Doodeman for his assistance with the statistical plan and analyses.

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Authors and Affiliations

  1. Department of Surgery, Red Cross Hospital Beverwijk, Beverwijk, Netherlands

    Nathalie Bakker, Rick S. van den Helder, Michiel A. Hunfeld, Huib A. Cense, Ahmet Demirkiran & Alexander P. J. Houdijk

  2. Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, Netherlands

    Nathalie Bakker, Rick S. van den Helder, Remy W. F. Geenen & Alexander P. J. Houdijk

  3. Department of Surgery, VU Medical Center Amsterdam, Amsterdam, Netherlands

    Nathalie Bakker & Alexander P. J. Houdijk

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  1. Nathalie Bakker
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  2. Rick S. van den Helder
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  3. Remy W. F. Geenen
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  4. Michiel A. Hunfeld
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  5. Huib A. Cense
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  7. Alexander P. J. Houdijk
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Correspondence to Nathalie Bakker.

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The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

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. Informed consent was obtained from all individual participants included in the study.

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Bakker, N., van den Helder, R.S., Geenen, R.W.F. et al. Four Weeks of Preoperative Omega-3 Fatty Acids Reduce Liver Volume: a Randomised Controlled Trial. OBES SURG 29, 2037–2044 (2019). https://doi.org/10.1007/s11695-019-03814-7

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  • DOI: https://doi.org/10.1007/s11695-019-03814-7

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