Effect of nutritional therapy on body composition and resting energy expenditure post bariatric surgery

doi:10.16139/j.1007-9610.2022.03.012

Abstract

Abstract:

Objectives To investigate the effect of nutritional therapy on body composition and resting energy expenditure(REE) post bariatric surgery in patients with obesity. Methods Six-step post-operative nutrition therapy during 3 months was performed for 47 patients undergoing bariatric surgery with laparoscopic sleeve gastrectomy. Body composition, REE and nutritonal biochemical indexes were determined in pre-surgery and post-surgery 1, 3 months. Predictive REE was calculated with Bernestin Formula. Repeated ANOVA analysis was done for the changes in the indicators of patients. Results Muscle mass reduced 8.33%±3.49% in post-surgery 1 month, and 2.86%±3.96% in post-surgery 3 months. Fat mass reduced 14.73%±5.44% in post-surgery 1 month and 16.61%±8.26% in post-surgery 3 months. There was no significant difference between REE and predicted REE with (9 339.16±2 620.59) kJ vs. (9 058.06±2 098.61) kJ in pre-surgery, P=0.593; and (7 228.20±2 066.61) kJ vs. (7 973.15±1 747.49) kJ in post-surgery 3 months, P=0.098. However, predicted REE (8 286.81±1 764.25) kJ was significant higher than REE (7 418.33±1 764.25) kJ in post-surgery 1 month, P=0.032. There was no significant difference in levels of vitamin-A, vitamin-B₁, vitamin-B₂, vitamin-B₆, vitamin-C and serum ferritin between pre-surgery and post-surgery 1 month and post-surgery 3 months(P>0.05). A significant reduction of C-reactive protein was present with (9.03±9.42) mg/L in pre-surgery, (6.61±7.89) mg/L in post-surgery 1 month and (4.69±4.66) mg/L in post-surgery 3 months, P=0.020. Conclusions Nutritional therapy after bariatric surgery 3 months could delay the loss of skeletal muscle mass and adapt REE and reduce the inflammation level in patients with obesity.

Key words: Bariatric surgery, Nutritional therapy, Body composition, Resting energy expenditure

CLC Number:

XUAN Chengjie, BIAN Dongsheng, JIANG Yongmei, CHEN Yufei, JIN Jiabin, SHI Yongmei. Effect of nutritional therapy on body composition and resting energy expenditure post bariatric surgery[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 244-248.

Figures/Tables 4

References 18

[1]	Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments[J]. Lancet, 2011, 378(9793):804-814. doi: 10.1016/S0140-6736(11)60813-1 pmid: 21872749
[2]	Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju ShN, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents[J]. Lancet, 2016, 388(10046):776-786. doi: 10.1016/S0140-6736(16)30175-1 pmid: 27423262
[3]	GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH. Health effects of overweight and obesity in 195 countries over 25 years[J]. N Engl J Med, 2017, 377(1):13-27. doi: 10.1056/NEJMoa1614362 URL
[4]	Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018[J]. Obes Surg, 2019, 29(3):782-795. doi: 10.1007/s11695-018-3593-1 pmid: 30421326
[5]	中华医学会肠外肠内营养学分会营养与代谢协作组, 北京协和医院减重多学科协作组. 减重手术的营养与多学科管理专家共识[J]. 中华外科杂志, 2018, 56(2):81-90.
[6]	Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabo-lic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery[J]. Endocr Pract, 2013, 19(2):337-372. doi: 10.4158/EP12437.GL pmid: 23529351
[7]	闫超. 超重肥胖人群静息能量消耗的测定及预测公式准确性的研究[D]. 河北医科大学, 2019.
[8]	Liu FY, Tu YF, Zhang P, et al. Decreased visceral fat area correlates with improved total testosterone levels after Roux-en-Y gastric bypass in obese Chinese males with type 2 diabetes: a 12-month follow-up[J]. Surg Obes Relat Dis, 2018, 14(4):462-468. doi: 10.1016/j.soard.2017.11.009 URL
[9]	Golzarand M, Toolabi K, Djafarian K. Changes in body composition, dietary intake, and substrate oxidation in patients underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a comparative prospective study[J]. Obes Surg, 2019, 29(2):406-413. doi: 10.1007/s11695-018-3528-x pmid: 30251098
[10]	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[J]. Obes Surg, 2017, 27(4):881-888. doi: 10.1007/s11695-016-2382-y pmid: 27677487
[11]	Müller MJ, Enderle J, Pourhassan M, et al. Metabolic adaptation to caloric restriction and subsequent refee-ding: the Minnesota starvation experiment revisited[J]. Am J Clin Nutr, 2015, 102(4):807-819. doi: 10.3945/ajcn.115.109173 URL
[12]	Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight[J]. N Engl J Med, 1995, 333(6):399. doi: 10.1056/NEJM199508103330628 URL
[13]	Bettini S, Bordigato E, Fabris R, et al. Modifications of resting energy expenditure after sleeve gastrectomy[J]. Obes Surg, 2018, 28(8):2481-2486. doi: 10.1007/s11695-018-3190-3 pmid: 29532316
[14]	Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition[J]. Obesity, 2016, 24(8):1612-1619. doi: 10.1002/oby.21538 pmid: 27136388
[15]	Moehlecke M, Andriatta BC, Rheinheimer J, et al. Early reduction of resting energy expenditure and successful weight loss after Roux-en-Y gastric bypass[J]. Surg Obes Relat Dis, 2017, 13(2):204-209. doi: S1550-7289(16)30201-5 pmid: 27692914
[16]	Tseng YH, Cypess AM, Kahn CR. Cellular bioenerge-tics as a target for obesity therapy[J]. Nature Reviews Drug Discovery, 2010, 9(6):465-482. doi: 10.1038/nrd3138 URL
[17]	Lowell BB, Spiegelman BM. Towards a molecular understanding of adaptive thermogenesis[J]. Nature, 2000, 404(6778):652-660. doi: 10.1038/35007527 URL
[18]	Li K, Zheng L, Guo J, et al. Increased resting energy expenditure/body weight and decreased respiratory quotient correlate with satisfactory weight loss after sleeve gastrectomy: a 6-month follow-up[J]. Obes Surg, 2020, 30(4):1410-1416. doi: 10.1007/s11695-019-04308-2 URL

指标	术前	术后1个月	术后3个月	F值	P值
体重（kg）	121.03±26.04	108.96±23.62	99.62±22.11	384.833	<0.001^a）
BMI（kg/m²）	42.62±6.85	38.41±6.44	35.08±6.06	419.465	<0.001^a）
FFM（kg）	62.38±14.32	58.01±12.55	56.47±13.11	91.384	<0.001^a）
肌肉量（kg）	35.16±8.57	32.21±7.57	31.29±7.96	110	<0.001^a）
FM（kg）	58.65±14.43	50.81±14.24	43.49±13.65	243.558	<0.001^a）
内脏脂肪面积（cm²）	243.81±28.17	224.21±39.22	195.11±48.52	97.489	<0.001^a）
细胞总水分（L）	465.85±10.57	42.76±9.18	41.41±19.56	84.785	<0.001^a）

指标	术前	术后1个月	术后3个月
预测REE（kJ）	9 058.06±2 098.61	8 286.81±1 764.25	7 973.15±1 747.49
REE（kJ）	9 339.16±2 620.59	7 418.33±1 764.25	7 228.20±2 066.61
t值	0.536	2.19	1.674
P值	0.593	0.032^a）	0.098

指标	术前	术后1个月	术后3个月	F值	P值
C反应蛋白（mg/L）	9.03±9.42	6.61±7.89	4.69±4.66	6.945	0.020^b）
前白蛋白（mg/L）	216.41±38.41	177.70±33.79	184.92±34.10	28.868	<0.001^b）
白蛋白（mg/L）	38.57±4.31	36.18±2.98	37.29±3.15	1.156	0.384
糖化血红蛋白^a）	6.29%±1.10%	5.60%±0.48%	5.09%±0.73%	22.208	<0.001^b）
维生素A（μmol/L）	0.91±0.40	0.98±0.49	1.02±0.81	0.494	0.613
维生素B₁（μmol/L）	65.23±16.46	63.15±9.39	62.62±8.41	0.566	0.571
维生素B₂（μmol/L）	261.95±73.83	284.42±127.69	241.92±38.61	1.349 6	0.234
维生素B₆（μmol/L）	29.62±18.60	32.04±17.87	29.62±14.80	0.3	0.742
维生素C（μmol/L）	39.89±5.27	38.69±5.21	40.89±7.87	0.95	0.394
铁蛋白（μg/L）	149.64±158.71	136.03±121.01	114.29±107.65	4.752	0.013^b）