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Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: 5 February 2025 | Viewed by 33503

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Special Issue Editors

Prof. Dr. Dorota Szostak-Węgierek

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Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E. Ciołka Str. 7, 01-445 Warsaw, Poland
Interests: nutrition; dietetics; nutritional epidemiology; cardiovascular diseases; dyslipidemia; diabetes; obesity; pregnancy; aging
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Wojciech Lisik

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Department of General Surgery and Transplantology, Medical University of Warsaw, 02-005 Warsaw, Poland
Interests: obesity in transplant recipients; bariatric surgery; emerging surgical procedures in metabolic surgery; metabolic dysfunction-associated fatty liver disease (MAFLD); ESLD for MAFLD
Special Issues, Collections and Topics in MDPI journals

Dr. Iwona Boniecka

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Guest Editor

Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E. Ciołka Str. 7, 01-445 Warsaw, Poland
Interests: nutrition; dietetics; obesity; bariatric dietetics; bariatric surgery; cardiovascular diseases; dyslipidemia; diabetes; kidney disease

Special Issue Information

Dear Colleagues,

We are very pleased to invite researchers to submit original or review papers on the diet and lifestyle management of patients undergoing bariatric surgery.

Obesity has become a kind of a pandemic nowadays, and morbid obesity is common. This has caused a rapid increase in the prevalence of its metabolic complications, among which diabetes, hypertension, dyslipidemia and resulting cardiovascular diseases are of the greatest concern. As diet and lifestyle management alone in patients with obesity, especially if severe, is not very effective, bariatric surgery interventions are very often undertaken. These interventions result in a rapid body mass decrease and attenuation of metabolic complications of obesity, improving quality of life and reducing the risk of death.

However, bariatric surgery requires a suitable preparation of the patient before surgery to reduce liver volume and ensure effective dietary management in the postoperative period. This surgery aims to both decrease fat mass and prevent potential side effects of the procedure, e.g., undernutrition and nutritional deficiencies. It is known that the success of bariatric surgery depends on both significant weight reduction and a change in eating habits.

In this Special Issue we aim to collect the latest studies presenting novel results and future perspectives in the areas discussed.

We welcome the submission of original research, review and expert opinions. The primary topics of interest are obesity, bariatric surgery and diet and lifestyle interventions before and after the procedure.

Prof. Dr. Dorota Szostak-Węgierek
Prof. Dr. Wojciech Lisik
Dr. Iwona Boniecka
Guest Editors

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Keywords

obesity
bariatric surgery
diet
nutrition
diabetes
metabolic syndrome
lifestyle
nutritional status
body composition
nutritional deficiencies

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Published Papers (9 papers)

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Research

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21 pages, 396 KiB

Open AccessArticle

Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients

by Iwona Boniecka, Aneta Czerwonogrodzka-Senczyna, Anna Jeznach-Steinhagen, Krzysztof Paśnik, Dorota Szostak-Węgierek and Samir Zeair

Nutrients 2023, 15(11), 2479; https://doi.org/10.3390/nu15112479 - 26 May 2023

Cited by 3 | Viewed by 2530

Abstract

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient’s diet deviated from recommendations and may have contributed to metabolic disorders. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

13 pages, 317 KiB

Open AccessArticle

Assessment of the Clinical Condition and Way of Patients’ Nutrition before and after Laparoscopic Sleeve Gastrectomy

by Marta Jastrzębska-Mierzyńska, Lucyna Ostrowska, Katarzyna Witczak-Sawczuk and Hady Razak Hady

Nutrients 2023, 15(3), 514; https://doi.org/10.3390/nu15030514 - 19 Jan 2023

Cited by 1 | Viewed by 2489

Abstract

One of the most commonly performed bariatric procedures is the laparoscopic sleeve gastrectomy (LSG). It is highly effective in reducing body weight, but it carries the risk of developing nutritional deficiencies and their consequences. The aim of the study was to determine the clinical condition of obese patients after LSG in terms of nutritional status, metabolic disorders, and way of nutrition. Thirty participants (15 women and 15 men) took part in the study. A statistically significant reduction in the total body fat mass (women by 37.5% p < 0.05, men by 37.06% p < 0.05) and total fat free mass (women by 10% p < 0,05, men by 12.5% p < 0.05) was demonstrated 6 months after LSG. Moreover, insufficient protein intake has been shown in over 73% of women and 40% of men. Before and 6 months after LSG, insufficient intake of calcium, magnesium, potassium, folate, vitamin D, and iron was observed. Six months after the LSG, significant decreases of fasting glucose (p < 0.05), insulin (p < 0.05), TG (p < 0.05), and AST (p < 0.05) concentrations, were observed in both groups. Optimization of nutrition in order to prevent nutritional deficiencies and their complications is a key element of the therapy of obese patients treated surgically. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

15 pages, 311 KiB

Open AccessArticle

Environmental Factors Determining Body Mass Index (BMI) within 9 Months of Therapy Post Bariatric Surgery—Sleeve Gastrectomy (SG)

by Agata Wawrzyniak and Monika Krotki

Nutrients 2022, 14(24), 5401; https://doi.org/10.3390/nu14245401 - 19 Dec 2022

Viewed by 8031

Abstract

Treatment of obesity should be multidirectional and include, in addition to bariatric surgery, changing the key factors of lifestyle and eating habits. The study aimed to assess the impact of bariatric surgery and dietary care on anthropometric measurements, blood pressure, changes in lifestyle, and eating habits of patients within 9 months after the procedure, with the selection of environmental factors determining BMI variation. The study included 30 SG patients before surgery (month zero) and at 1, 3, 6, and 9 months after SG. Patients completed a questionnaire regarding age, sex, place of residence, education, professional activity, number of family members, financial situation, family history of obesity, previous forms of therapy, self-assessment of nutritional knowledge, receiving and following nutritional recommendations, eating habits, frequency of body weight control, leisure time. Body weight, height, waist and hip circumference, and systolic and diastolic pressure were measured, and BMI and WHR (Waist to Hip Ratio) were calculated. Within 9 months after the procedure, the patients’ body weight and BMI decreased on average by 26%. Post bariatric surgery, patients changed their eating habits. The influence of bariatric SG surgery and time after surgery was decisive for the normalization of BMI and explained the 33% variation in BMI up to 9 months after the procedure. Other factors important for the normalization of BMI after surgery were: male gender, older age of patients, family obesity (non-modifiable factors), as well as previous forms of therapy related to weight loss before surgery, shortening the intervals between meals and stopping eating at night (modifiable factors). The tested model explained 68% of the BMI variation after SG surgery for all assessed factors. Changes in lifestyle and eating habits in bariatric patients are crucial to maintaining the effect of bariatric surgery. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

16 pages, 2507 KiB

Open AccessArticle

Association between Fecal Microbiota, SCFA, Gut Integrity Markers and Depressive Symptoms in Patients Treated in the Past with Bariatric Surgery—The Cross-Sectional Study

by Natalia Komorniak, Alexandra Martynova-Van Kley, Armen Nalian, Michał Wroński, Krzysztof Kaseja, Bartosz Kowalewski, Karolina Kaźmierczak-Siedlecka, Igor Łoniewski, Mariusz Kaczmarczyk, Konrad Podsiadło, Paweł Bogdański, Joanna Palma and Ewa Stachowska

Nutrients 2022, 14(24), 5372; https://doi.org/10.3390/nu14245372 - 17 Dec 2022

Cited by 8 | Viewed by 3735

Abstract

(1) Background: Depressive symptoms often appear after surgical treatment. (2) Methods: We involved 41 adults who underwent bariatric surgery a minimum of 6 months before the study and had the Beck scale ≥12. We analysed patients’ mental state, gut barrier markers, faecal short chain fatty acids, and microbiota. (3) Results: Gut microbiota composition differed significantly among patients undergoing two different types of surgery (F = 1.64, p = 0.00002). Additionally, we discovered an association between short chain fatty acids and the Beck scale (F = 1.22, p = 0.058). The rearrangement of bacterial metabolites may be due to the patients’ use of increased dietary protein, with insufficient intake of products containing vegetable fiber (Diet Quality Index (DQI-I )adequacy 22.55 (±3.46) points). (4) Conclusions: Bariatric surgery affects the gut microbiota, which may play an important role in the development of depressive and gastrointestinal symptoms in patients after bariatric surgery. Low fiber consumption and increased levels of faecal isobutyric acid may lead to intestinal inflammation. There is a need for further research on this topic including a larger sample size. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

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12 pages, 629 KiB

Open AccessArticle

Development and Validation of Dietary Behavior Inventory—Surgery (DBI-S) in the Scope of International Post-Bariatric Surgery Guidelines and Recommendations

by Alexander Bäuerle, Laura Schräpler, Matthias Marsall, Gerrit Engelmann, Nadja Knoll-Pientka, Lynik Chantal Schüren, Marco Niedergethmann, Anita Robitzsch, Eva-Maria Skoda, Till Hasenberg and Martin Teufel

Nutrients 2022, 14(18), 3692; https://doi.org/10.3390/nu14183692 - 7 Sep 2022

Cited by 3 | Viewed by 1928

Abstract

(1) Dietary behavior is highly relevant for patients after bariatric surgery. No instrument exists assessing adherence to medical guidelines concerning the dietary behavior of patients after bariatric surgery. The aim of this study was to develop and validate such an instrument. (2) Data from patients after bariatric surgery (n = 543) were collected from March to May 2022. The development of the DBI-S was theory-based and interdisciplinary. Items’ and content validity of the DBI-S were examined. (3) The final version of the DBI-S consists of 13 items. Convergent validation was confirmed by significant correlations between DBI-S score and attitude towards healthy food (r = 0.26, p = <0.001) and impulsivity (r = −0.26, p = <0.001). Criterion validity was confirmed by significant correlations between DBI-S score and pre-/post-surgery BMI difference (r = −0.14, p = 0.002), pre-/post-surgery weight difference (r = 0.13, p = 0.003), and quality of life (r = 0.19, p = <0.001). Cluster analysis confirmed the ability to distinguish between two dietary behavior clusters (rather healthy and rather unhealthy). (4) The DBI-S is an economic and valid instrument to assess the adherence of post-bariatric surgery patients to the relevant dietary behavior recommendations and guidelines and can distinguish between rather unhealthy and healthy dietary behavior. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

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8 pages, 718 KiB

Open AccessArticle

Do Lifestyle Interventions before Gastric Bypass Prevent Weight Regain after Surgery? A Five-Year Longitudinal Study

by Salvatore Vaccaro, Leila Itani, Francesca Scazzina, Stefano Bonilauri, Concetto Maria Cartelli, Marwan El Ghoch and Massimo Pellegrini

Nutrients 2022, 14(17), 3609; https://doi.org/10.3390/nu14173609 - 31 Aug 2022

Cited by 3 | Viewed by 2666

Abstract

It is unclear whether weight loss (WL) achieved by means of lifestyle interventions (LSIs) before bariatric surgery (BS) can improve long-term WL outcomes after surgery. We aimed to assess the impact of a structured LSI on WL% after gastric bypass (GBP). Two groups of patients were selected from a large cohort of participants with obesity who underwent GBP surgery at Santa Maria Nuova Hospital (Reggio Emilia, Italy). The groups were categorized as those who have or have not received LSI prior to GBP. The LSI group included 91 participants (cases) compared to 123 participants (controls) in the non-LSI group. WL% was measured at follow-up times of 1, 3, 6, 12, 24, 36, 48, and 60 months. The LSI group achieved a clinically significant WL% (−7.5%) before BS, and at the time of surgery, the two groups had similar body weights and demographic statuses. At all points, until the 24-month follow-up, the two groups displayed similar WLs%. With regard to the longer follow-ups, the LSI group maintained weight loss until the last timepoint (60 months), whereas the non-LSI group experienced weight regain at 36, 48, and 60 months. In a real-world context, a structured behavioral LSI prior to GBP seems to prevent longer-term weight regain. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

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12 pages, 304 KiB

Open AccessArticle

Comparison of Perceived Weight Discrimination between Polish and German Patients Underwent Bariatric Surgery or Endoscopic Method versus Conservative Treatment for Morbid Obesity: An International Multicenter Study

by Karolina Hoffmann, Anna Paczkowska, Wiesław Bryl, Kinga Marzec, Jonas Raakow, Matthias Pross, Rafael Berghaus, Elżbieta Nowakowska, Krzysztof Kus and Michał Michalak

Nutrients 2022, 14(13), 2775; https://doi.org/10.3390/nu14132775 - 5 Jul 2022

Cited by 3 | Viewed by 2478

Abstract

Objectives: The aim of this study was to compare the level of discrimination among patients with obesity living in Poland and Germany. Methods: This was a retrospective cross-sectional international multicenter survey study including 564 adult participants treated for morbid obesity at selected healthcare facilities in Germany (210 patients) and in Poland (354 patients). Discrimination was evaluated using a custom-made questionnaire based on the related literature. Results: The level of obesity discrimination did not differ between German and Polish patients (p = 0.4282). The presence of obesity was reported to be associated to a large or a very large extent with the feeling of social exclusion and discrimination by 46.63% of German participants and 42.09% of Polish ones (p = 0.2934). The mean level of discrimination related to the lack of employment was higher in patients who underwent bariatric surgery or endoscopic method than in those who underwent conservative treatment (for Germany: 2.85 ± 1.31 (median, 3) vs. 2.08 ± 1.31 (median, 1), p = 0.002; for Poland: 2.43 ± 1.15 (median, 2) vs. 1.93 ± 1.15 (median, 1), p = 0.005). The level of discrimination was associated with sex, age, the degree of obesity, and treatment-related weight loss (p < 0.05). Conclusions: Our findings confirm that obesity significantly affects the social and economic well-being of patients. There is a great need to reduce weight stigma and to take measures to alleviate the socioeconomic and psychological burden of obesity. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

Review

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19 pages, 1156 KiB

Open AccessReview

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery

by Monika Bąk-Sosnowska and Beata Naworska

Nutrients 2023, 15(19), 4289; https://doi.org/10.3390/nu15194289 - 8 Oct 2023

Cited by 1 | Viewed by 3349

Abstract

Chronic diseases are potential risk factors for pregnancy duration and neonatal outcomes. This narrative review aimed to summarize the research results on the specifics of pregnancy in women with obesity and after bariatric surgery. PubMed and Google Scholar databases were searched. Systematic reviews, meta-analyses, clinical trials, and references to identified articles from the last ten years (2013–2023) were included. Ultimately, 107 literature items were qualified. It has been shown that women with obesity planning pregnancy should reduce their body weight because obesity is a risk factor for adverse obstetric and neonatal outcomes. Bariatric surgery effectively reduces excessive body weight and the health risks in women with obesity during pregnancy and their offspring. However, at least a year interval between surgery and conception is recommended. An interdisciplinary medical team should provide patient care during pregnancy with knowledge and skills related to people after bariatric surgery. Due to the increased risk of mental disorders, especially depression, it is necessary to constantly monitor the mental state of women and provide psychological support and education on a healthy lifestyle during pregnancy and the postpartum period. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

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19 pages, 960 KiB

Open AccessFeature PaperReview

Diet Management of Patients with Chronic Kidney Disease in Bariatric Surgery

by Marta Potrykus, Sylwia Czaja-Stolc, Sylwia Małgorzewicz, Monika Proczko-Stepaniak and Alicja Dębska-Ślizień

Nutrients 2023, 15(1), 165; https://doi.org/10.3390/nu15010165 - 29 Dec 2022

Cited by 7 | Viewed by 4927

Abstract

Morbid obesity is considered a civilization disease of the 21st century. Not only does obesity increase mortality, but it is also the most important cause of the shortening life expectancy in the modern world. Obesity is associated with many metabolic abnormalities: dyslipidemia, hyperglycemia, cardiovascular diseases, and others. An increasing number of patients diagnosed with chronic kidney disease (CKD) are obese. Numerous additional disorders associated with impaired kidney function make it difficult to conduct slimming therapy and may also be associated with a greater number of complications than in people with normal kidney function. Currently available treatments for obesity include lifestyle modification, pharmacotherapy, and bariatric surgery (BS). There are no precise recommendations on how to reduce excess body weight in patients with CKD treated conservatively, undergoing chronic dialysis, or after kidney transplantation. The aim of this study was to analyze studies on the bariatric treatment of obesity in this group of people, as well as to compare the recommendations typical for bariatrics and CKD. Full article

(This article belongs to the Special Issue Diet and Lifestyle Management of Patients Undergoing Bariatric Surgery)

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