Tolerance to Specific Foods After Laparoscopic Sleeve Gastrectomy

Abstract

Purpose

We assessed the degree of tolerance to different types of food after LSG to provide specific useful advice concerning food intake to these patients during the first postoperative year.

Methods

A specific questionnaire measuring tolerance to 59 types of food was completed in postoperative months 1, 3, 6, 9, and 12 in a prospective consecutive cohort of patients who underwent LSG. An ordinal score of tolerance based on the median (Me) and a cumulative link ordinal model (CLOM) analyzing temporal variability in oral tolerance to each type of food were used. Foods with Me values of 3 points or higher and CLOM values of approximately 80% or higher were considered well tolerated.

Results

Sixty-five patients were included in the study. The questionnaire was completed in the first, third, sixth, ninth, and twelfth months by 42 (64%), 44 (67%), 41 (63%), 41 (63%), and 39 (60%) patients, respectively. All kinds of fish were very well tolerated. Regarding meat intake, chicken, turkey, rabbit, and minced meat were well tolerated, whereas lamb, veal, and pork were not. Except for noodles and toasted bread, a poor degree of tolerance during follow-up was found for most carbohydrates. Yogurt, skimmed milk, and cottage cheese were well tolerated. A heterogeneous degree of tolerance was observed for vegetables, with cooked vegetables being well tolerated, and raw vegetables not.

Conclusion

Our study provides individual information on specific foods regarding their degree of tolerance. This information may be useful for advising patients during the first postoperative year after LSG.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Ali M, El Chaar M, Ghiassi S, et al. American society for metabolic and bariatric surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652–7.

    Article  Google Scholar 

  2. 2.

    Schweiger C, Weiss R, Keidar A. Effect of different bariatric operations on food tolerance and quality of eating. Obes Surg. 2010;20(10):1393–9.

    Article  Google Scholar 

  3. 3.

    Nogués X, Goday A, Jesus Peña M, et al. Bone mass loss after sleeve gastrectomy: a prospective comparative study with gastric bypass. Cir Esp Engl Ed. 2010;88(2):103–9.

    Article  Google Scholar 

  4. 4.

    Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.

    Article  CAS  Google Scholar 

  5. 5.

    Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9.

    Article  Google Scholar 

  6. 6.

    Faria SL, Faria OP, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798–805.

    Article  Google Scholar 

  7. 7.

    Friedrich AE, Damms-Machado A, Meile T, et al. Laparoscopic sleeve gastrectomy compared to a multidisciplinary weight loss program for obesity—effects on body composition and protein status. Obes Surg. 2013;23(12):1957–65.

    Article  Google Scholar 

  8. 8.

    Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity. 2013;28(4):1–58.

    Article  CAS  Google Scholar 

  9. 9.

    Stein J, Stier C, Raab H, et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609.

    Article  CAS  Google Scholar 

  10. 10.

    Chambrier C, Sztark F, Société Francophone de nutrition clinique et métabolisme (SFNEP), Société française d’anesthésie et réanimation (SFAR). French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg. 2012;149(5):e325–36.

    Article  CAS  Google Scholar 

  11. 11.

    Oria HE, Moorehead MK. Bariatric Analysis and Reporting Outcome System (BAROS). Obes Surg. 8:487–99.

  12. 12.

    Oria HE. How to use the bariatric analysis and reporting outcome system. Surg Obes Relat Dis. 2012;8(1):130–1.

    Article  Google Scholar 

  13. 13.

    Suter M, Calmes J-M, Paroz A, et al. A new questionnaire for quick assessment of food tolerance after bariatric surgery. Obes Surg. 2007;17(1):2–8.

    Article  Google Scholar 

  14. 14.

    Shai I, Henkin Y, Weitzman S, et al. Long-term dietary changes after vertical banded gastroplasty: is the trade-off favorable? Obes Surg. 2002;12(6):805–11.

    Article  Google Scholar 

  15. 15.

    Ernst B, Thurnheer M, Wilms B, et al. Differential changes in dietary habits after gastric bypass versus gastric banding operations. Obes Surg. 2009;19(3):274–80.

    Article  Google Scholar 

  16. 16.

    Ruiz-Tovar J, Bozhychko M, Del-Campo JM, et al. Changes in frequency intake of foods in patients undergoing sleeve gastrectomy and following a strict dietary control. Obes Surg. 2018;28(6):1659–64.

    Article  Google Scholar 

  17. 17.

    IDF consensus worldwide definition of the metabolic syndrome 2006. 2019. https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome

  18. 18.

    Ruiz-Tovar J, Muñoz JL, Royo P, et al. Implementation of the Spanish ERAS program in bariatric surgery. Minim Invasive Ther Allied Technol. 2018;27(6):365–72.

    Article  Google Scholar 

  19. 19.

    Ramon JM, Gonzalez CG, Dorcaratto D, et al. Quality of food intake after bariatric surgery: vertical gastrectomy versus gastric bypass. Cir Esp. 2012;90(2):95–101.

    Article  Google Scholar 

  20. 20.

    Gonzalez-Campoy JM, St Jeor ST, Castorino K, et al. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013;19(Suppl 3):1–82.

    Article  Google Scholar 

  21. 21.

    Freeman RA, Overs SE, Zarshenas N, et al. Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Res Clin Pract. 2014;8(2):e115–200.

    Article  Google Scholar 

  22. 22.

    Cano-Valderrama O, Sanchez-Pernaute A, Rubio-Herrera MA, et al. Long-term food tolerance after bariatric surgery: comparison of three different surgical techniques. Obes Surg. 2017;27:2868–72.

    Article  Google Scholar 

  23. 23.

    Ruiz-Tovar J, Bozhychko M, Del-Campo JM, et al. Food tolerance and quality of alimentation following laparoscopic sleeve gastrectomy calibrated with a 50-Fr Bougie: long-term results. J Laparoendosc Adv Surg Tech A. 2018;28(6):721–5.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Antonio Arroyo.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

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

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 29 kb).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Diaz-Lara, C., Curtis, C., Romero, M. et al. Tolerance to Specific Foods After Laparoscopic Sleeve Gastrectomy. OBES SURG 30, 3891–3897 (2020). https://doi.org/10.1007/s11695-020-04732-9

Download citation

Keywords

  • Morbid obesity
  • Laparoscopic sleeve gastrectomy
  • LSG
  • Food tolerance
  • Food recommendations