Looking At Nutritional Deficiencies Pre & Post Gastric Sleeve

Nutrient deficiencies before and after sleeve gastrectomy.

BACKGROUND:

Obesity is associated with nutritional deficiencies. Bariatric surgery could worsen these deficiencies. Fewer nutritional deficiencies would be seen after sleeve gastrectomy compared to the Roux-en-Y gastric bypass, but sleeve gastrectomy would also cause further deterioration of the deficiencies. The aim of this study was to determine the amount of pre-operative nutrient deficiencies in sleeve gastrectomy patients and assess the evolution of the nutritional status during the first post-operative year.

METHODS:

Four hundred and seven sleeve gastrectomy patients were assigned to a standardized follow-up program. Data of interest were weight loss, pre-operative nutrient status and evolution of nutrient deficiencies during the first post-operative year. Deficiencies were supplemented when found.

RESULTS:

Two hundred patients completed blood withdrawal pre-operatively and in the first post-operative year. pre-operatively, 5 % of the patients were anaemic, 7 % had low serum ferritin and 24 % had low folic acid. Hypovitaminosis D was present in 81 %. Vitamin A had excessive levels in 72 %. One year post-operatively, mean excess weight loss was 70 %. Anaemia was found in 6 %. Low-ferritin levels were found in 8 % of the patients. Folate deficiency decreased significantly and hypovitaminosis D was still found in 36 %.

vitamins, pills and tablets
vitamins, pills and tablets

CONCLUSIONS:

In this study, a considerable amount of patients suffered from a deficient micronutrient status pre-operatively. One year after surgery, micronutrient deficiencies persisted or were found de novo in a considerable amount of patients, despite significant weight loss and supplementation. Significant reductions were seen only for folate and vitamin D.

 

Source: Obes Surg. 2014 Oct;24(10):1639-46. doi: 10.1007/s11695-014-1225-y.

 

Authors: Van Rutte PW, Aarts EO, Smulders JF, Nienhuijs SW

 

Why We Should Prevent Our Children Becoming Obese

Understanding risk factors that contribute to childhood obesity

As the rate of obesity in the U.S. population has risen dramatically, more and more children are becoming overweight at younger and younger ages. Understanding the factors that contribute to childhood obesity and identifying ways to prevent its development are critical to stemming the historically high prevalence of childhood obesity and of associated health problems like type 2 diabetes. Two articles receiving online publication in the American Journal of Preventive Medicine describe systematic reviews of the results of studies investigating either risk factors that contribute to childhood obesity or interventions that could prevent it during the first 1,000 days of life – from conception to age 2.

pregnancy-943202_960_720

“We know that obesity is notoriously difficult to treat, and evidence suggests that reducing risk factors for childhood obesity during pregnancy, infancy, and early childhood could prevent children from becoming overweight in the first place,” says Elsie Taveras, MD, MPH, chief of General Academic Pediatrics at MassGeneral Hospital for Children (MGHfC) and senior author of both papers. “While our reviews were able to identify a few early-lifetime risk factors and interventions that appear to have some effectiveness, the studies we found were quite limited in both the factors that were examined and the interventions that were tested.”

The childhood obesity risk-factors review led by Jennifer Woo Baidal who is an assistant professor of Pediatrics at Columbia, MD, MPH – previously an MGHfC General Academic Pediatrics research fellow and now with the division of Pediatric Gastroenterology at Columbia University Medical Center – analyzed the results of 282 studies published from 1980 through 2014. Across all of the studies, only a few factors were consistently associated with an increased risk of a child being overweight or obese at the end of the study periods, which ranged from age 6 months to 18 years. Maternal factors were smoking, elevated prepregnancy weight and excess weight gain during pregnancy; factors applying to children were high birth weight and rapid weight gain during the first months after birth. While the largest number of studies focused on breastfeeding, evidence for any impact on obesity risk was inconsistent.

big baby 1

The review of intervention studies was led by Tiffany Blake-Lamb, MD, MSc, an obstetrician in the Massachusetts General Hospital Vincent Memorial Department of Obstetrics and Gynecology, and examined 34 articles published during the same time period that reported on the outcomes of 26 unique interventions. Neither of two prenatal interventions – one that included dietary advice, coaching, and exercise during pregnancy, and one focused on treating women with mild gestational diabetes – appeared to alter the incidence of obesity among offspring.

Two of six interventions that began during pregnancy and continued into infancy, both of which involved home visits focusing on the mother’s diet and infant feeding, reduced the risk of overweight in later years. Other interventions that had some success focused on the mother’s physical activity and diet, parenting practices related to the feeding of children, and behavioral counseling. Interventions featuring the use of high-protein and enriched formulas actually increased the risk of obesity, while the use of formulas with hydrolyzed protein, which is believed to promote infant satiety, stemmed infants’ rate of growth during the first year of life.

The authors were surprised that none of the studied interventions targeted helping mothers achieve a healthy weight before the start of their pregnancy, preventing prenatal and early-life tobacco exposure, or reducing the introduction of sugary beverages. Many interventions related to infant feeding focused solely on breastfeeding and did not include strategies to prevent obesity in formula-fed infants. Although the effective interventions were applied in settings ranging from the home to the community, the complexity of factors contributing to obesity risk suggests that interventions need to extend beyond simply the diet and activity levels of individual children and mothers.

“While most interventions that have been completed to date focus on individual behavioral change, it is clear that multiple and overlapping factors contribute to obesity risk,” says Blake-Lamb, who is also a fellow with the Kraft Center for Community Health Leadership at Partners HealthCare. “The limited success of these interventions suggests that many, and possibly more influential, factors related to social influences and the community environment – including food subsidies and fast-food marketing – may have a powerful impact on the risk of childhood obesity. Future interventions should address multiple obesity risk factors and be based on conceptual frameworks that recognize the multi-layered and inter-generational complexity of factors contributing to obesity risk.”

Taveras adds, “Future research focused on risk factors during pregnancy should examine the mechanisms through which those factors lead to obesity risk and how successful interventions alter those mechanisms. A broader investigation of the impact of diet and feeding practices, and perhaps their effects on the infant microbiome, could identify new targets for intervention, and while maternal risk factors are clearly important, future studies also should examine the role of fathers and other caretakers in obesity risk. Studies also need to include populations that are more diverse in terms of both racial/ethnic backgrounds and socioeconomic status.”

Source:

Massachusetts General Hospital

 

Threat Of Birth Defects For Post Gastric Bypass Patients

Female adolescent gastric bypass patients face increased risk of neural tube defects

There is a possible link between gastric bypass surgery in adolescent girls and an increased risk for neural tube defects in their children, according to a case study presented at the Academy of Paediatrics National Conference and Exhibition in San Francisco, CA. Neural tube defects can lead to varying degrees of disability such as paralysis and mental retardation due to damage to the nervous system.

The report, ‘Neural Tube Defects: An Unforeseen Consequence of Gastric Bypass Surgery in Young Female Patients?’ reviewed the case of a young patient who had undergone gastric bypass surgery prior to becoming pregnant. She presented to the Foetal Treatment Centre at UCSF Benioff Children’s Hospital to discuss the possibility of foetal surgery as her foetus had spina bifida.

A literature review found six additional documented cases of children born with neural tube defects thought to be due to maternal nutritional deficiencies, particularly malabsorption, following bypass surgery.

Gastric bypass surgery can lead to malabsorption, causing multiple nutritional deficiencies, including folate (folic acid), which is a key element in the prevention of neural tube defects. Despite daily folate replacement being supplied to reverse this deficiency, adolescents rarely comply with medication regimens. This situation is especially critical because adolescents who have undergone gastric bypass surgery are at an increased risk of unintended pregnancies.

“We postulate that the malabsorption of folate, poor compliance with nutritional supplements and a higher risk of unintended pregnancies places young women at an increased risk for pregnancies complicated with neural tube defects,” said senior study author Dr Diana L Farmer. “Although obesity is epidemic in this country, we believe non-reversible gastric bypass surgery should be avoided in adolescent women given the potential increased risk of foetal neural tube defects.

However, she added that if gastric bypass is performed on an adolescent female, great efforts should be made to minimise the risks of both unintended pregnancies and nutritional deficiencies. This should include extensive pre-surgery counselling and frequent post-operative follow-up, as well as consideration of highly efficacious contraceptives such as an intra-uterine device.

Source: American Academy Of Paediatrics

Authors: Katrine M Loftberg MD, Diana Farmer MD, Elizabeth A Gress, Robert H Lustig and Melvin B Heyman

 

How Psychological Characteristics Affect Outcome & Success

A comparison of behavioural and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity

 

Patients use choose bariatric surgery compared to conservative weight loss treatments, had more positive expectations of the treatment outcomes and stronger beliefs, according to researchers from the Oslo Bariatric Surgery Study (OBSS). The paper titled, ‘A comparison of behavioural and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity’ published in the BMC Obesity, also stated that patients starting conservative treatment had stronger beliefs in readiness to change physical activity levels.

 

It is known that a patient’s psychological characteristics can impact the success from bariatric surgery. Previous studies looking at the differences between surgical and non-surgical patients have focused on psychopathological factors, such as depression, anxiety, eating disorders or problematic eating behaviours. The most consistent finding is that surgical patients more frequently report high levels of depressive symptoms than non-surgical patients.

The aim of the study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioural and psychosocial characteristics. This then was considered predictors of their adoption of and adherence to long-term lifestyle recommendations. The study measured characteristics in both groups, such as self-efficacy, motivation, goal attainment, mental health, and social support.

The study used the data from the Oslo Bariatric Surgery Study which is a prospective study on the two groups of patients that will be followed up over a period of 10 years. The clinical paper goes into detail on the measures used to recruit patients and their outcomes. The results showed that the surgical group were younger, a higher percentage were female and had a higher BMI. Patients belonging to this group also reported a high frequency of drinking soda, using unhealthy weight reduction methods and had a family history of obesity. In addition they had a longer history of dieting, participated more often in organised weight loss programmes and had lost more than 10 kilos in the past.

Overall there were few differences regarding self-evaluative and mental health factors. The surgical group reported higher levels of depressive symptoms and fewer binge eating episodes. They also exhibited more dispositional resilience and a realistic life orientation and structured style giving them the ability to keep daily routines, to plan and to be organised compared to the non-surgical group.

The researchers report that the most notable group difference were that the patients opting for bariatric surgery scored higher on factors considered central to initiating and maintaining behaviour change, such as higher general self-efficacy, weight loss goals, and expectations of increased well-being in the future, as a result of the surgery.

“The pre-treatment differences in psychological predictors indicate that the results of studies addressing effective behaviour change and weight loss maintenance programmes for conservative weight loss treatment patients may, with some adjustments, also apply to patients undergoing bariatric surgery” the researchers write…..

“Our findings imply that future research may examine how high outcome goals and expectations interact with depressive symptoms depending on the degree of weight loss throughout the post-operative course”. They concluded that future studies should explore the effect of interventions for bariatric surgery patients, promoting post op physical activity and stressing realistic outcome expectations.

 

Reference: BMC Obesity BMC Series 2016 3:6 DOI:10.1186/s 40608-016-0084-6

 

Authors: Ingela Lundin Kvalem, Irmelin Bergh, Tilmann von Soest, Jan H Rosenvinge, Tina Avantis Johnsen, Egil W Martinsen. Tom Mala and Jon A Kristinsson

 

Your Partner Could Be Making You Fat!

Partner’s lifestyle has greater influence on obesity risk

The lifestyle a person shares with their partner has a greater influence on their chances of becoming obese than their upbringing, research suggests.

By middle age, choices made by couples – including those linked to diet and exercise – have a much greater impact than the lifestyle each shared with siblings and parents growing up.

Although by middle age siblings have a shared risk of being obese, this is mostly attributable to their shared genetic inheritance rather than any habits instilled during their shared upbringing.

Researchers say the study will help scientists better understand links between obesity, genetics and lifestyle habits.

Its findings reinforce the message that lifestyle changes in adulthood can have a significant impact in tackling obesity, regardless of a person’s genetic profile.

fat couple 1

The team analysed data provided by 20,000 people from Scottish families. They compared people’s family genetics and home environments in childhood and adulthood and related these to measures linked to health and obesity.

A total of 16 measures were considered including, waist to hip ratio, blood pressure, body fat content and body mass index.

The information was originally gathered as part of the Generation Scotland project – a national resource of health data that helps researchers to investigate genetic links to health conditions.

The study has been published in the journal PLOS Genetics and was led by Professor Chris Haley of the Medical Research Council’s Human Genetics Unit at the University of Edinburgh.

Professor Haley said: “Although genetics accounts for a significant proportion of the variation between people, our study has shown that the environment you share with your partner in adulthood also influences whether you become obese and this is more important than your upbringing. The findings also show that even people who come from families with a history of obesity can reduce their risk by changing their lifestyle habits.”

Source:

University of Edinburgh

 

Are Fat Babies Healthy Babies?

Understanding risk factors that contribute to childhood obesity

As the rate of obesity in the U.S. population has risen dramatically, more and more children are becoming overweight at younger and younger ages. Understanding the factors that contribute to childhood obesity and identifying ways to prevent its development are critical to stemming the historically high prevalence of childhood obesity and of associated health problems like type 2 diabetes. Two articles receiving online publication in the American Journal of Preventive Medicine describe systematic reviews of the results of studies investigating either risk factors that contribute to childhood obesity or interventions that could prevent it during the first 1,000 days of life – from conception to age 2.

Pregnant

“We know that obesity is notoriously difficult to treat, and evidence suggests that reducing risk factors for childhood obesity during pregnancy, infancy, and early childhood could prevent children from becoming overweight in the first place,” says Elsie Taveras, MD, MPH, chief of General Academic Pediatrics at MassGeneral Hospital for Children (MGHfC) and senior author of both papers. “While our reviews were able to identify a few early-lifetime risk factors and interventions that appear to have some effectiveness, the studies we found were quite limited in both the factors that were examined and the interventions that were tested.”

The childhood obesity risk-factors review led by Jennifer Woo Baidal who is an assistant professor of Pediatrics at Columbia, MD, MPH – previously an MGHfC General Academic Pediatrics research fellow and now with the division of Pediatric Gastroenterology at Columbia University Medical Center – analyzed the results of 282 studies published from 1980 through 2014. Across all of the studies, only a few factors were consistently associated with an increased risk of a child being overweight or obese at the end of the study periods, which ranged from age 6 months to 18 years. Maternal factors were smoking, elevated prepregnancy weight and excess weight gain during pregnancy; factors applying to children were high birth weight and rapid weight gain during the first months after birth. While the largest number of studies focused on breastfeeding, evidence for any impact on obesity risk was inconsistent.

big baby 1

The review of intervention studies was led by Tiffany Blake-Lamb, MD, MSc, an obstetrician in the Massachusetts General Hospital Vincent Memorial Department of Obstetrics and Gynecology, and examined 34 articles published during the same time period that reported on the outcomes of 26 unique interventions. Neither of two prenatal interventions – one that included dietary advice, coaching, and exercise during pregnancy, and one focused on treating women with mild gestational diabetes – appeared to alter the incidence of obesity among offspring.

Two of six interventions that began during pregnancy and continued into infancy, both of which involved home visits focusing on the mother’s diet and infant feeding, reduced the risk of overweight in later years. Other interventions that had some success focused on the mother’s physical activity and diet, parenting practices related to the feeding of children, and behavioral counseling. Interventions featuring the use of high-protein and enriched formulas actually increased the risk of obesity, while the use of formulas with hydrolyzed protein, which is believed to promote infant satiety, stemmed infants’ rate of growth during the first year of life.

The authors were surprised that none of the studied interventions targeted helping mothers achieve a healthy weight before the start of their pregnancy, preventing prenatal and early-life tobacco exposure, or reducing the introduction of sugary beverages. Many interventions related to infant feeding focused solely on breastfeeding and did not include strategies to prevent obesity in formula-fed infants. Although the effective interventions were applied in settings ranging from the home to the community, the complexity of factors contributing to obesity risk suggests that interventions need to extend beyond simply the diet and activity levels of individual children and mothers.

“While most interventions that have been completed to date focus on individual behavioral change, it is clear that multiple and overlapping factors contribute to obesity risk,” says Blake-Lamb, who is also a fellow with the Kraft Center for Community Health Leadership at Partners HealthCare. “The limited success of these interventions suggests that many, and possibly more influential, factors related to social influences and the community environment – including food subsidies and fast-food marketing – may have a powerful impact on the risk of childhood obesity. Future interventions should address multiple obesity risk factors and be based on conceptual frameworks that recognize the multi-layered and inter-generational complexity of factors contributing to obesity risk.”

Taveras adds, “Future research focused on risk factors during pregnancy should examine the mechanisms through which those factors lead to obesity risk and how successful interventions alter those mechanisms. A broader investigation of the impact of diet and feeding practices, and perhaps their effects on the infant microbiome, could identify new targets for intervention, and while maternal risk factors are clearly important, future studies also should examine the role of fathers and other caretakers in obesity risk. Studies also need to include populations that are more diverse in terms of both racial/ethnic backgrounds and socioeconomic status.”

Source:

Massachusetts General Hospital

 

Could The Air We Breathe Make Us Fat?

Air pollution exposure increases obesity risk

Laboratory rats who breathed Beijing’s highly polluted air gained weight and experienced cardio-respiratory and metabolic dysfunctions after three to eight weeks of exposure.

A study appearing in the March issue of the Journal of the Federation of American Societies for Experimental Biology (FASEB) placed pregnant rats and their offspring in two chambers, one exposed to outdoor Beijing air and the other containing an air filter that removed most of the air pollution particles.

air pollution

After only 19 days, the lungs and livers of pregnant rats exposed to the polluted air were heavier and showed increased tissue inflammation. These rats had 50 percent higher LDL cholesterol; 46 percent higher triglycerides; and 97 percent higher total cholesterol. Their insulin resistance level, a precursor of Type 2 diabetes, was higher than their clean air-breathing counterparts.

All of these measures support the study’s conclusion that air pollution exposure results in metabolic dysfunction, a precursor to obesity. Indeed, pollution-exposed rats were significantly heavier at the end of their pregnancy even though the rats in both groups were fed the same diet.

Similar results were shown in the rat offspring, which were kept in the same chambers as their mothers.

However, the results showed that the negative effects of air pollution were less pronounced after three weeks than they were at eight weeks, suggesting that long-term exposure may be needed to generate the continuous inflammatory and metabolic changes that ultimately increase body weight. At eight weeks old, female and male rats exposed to the pollution were 10 percent and 18 percent heavier, respectively, than those exposed to clean air.

The results of this study, which was funded by several agencies of the Chinese government, are consistent with other studies that show air pollution induces oxidative stress and inflammation in the organs and circulatory system. The findings also echo previous studies linking air pollution with increased insulin resistance and altered fat tissue.

air pollution 1

“Since chronic inflammation is recognized as a factor contributing to obesity and since metabolic diseases such as diabetes and obesity are closely related, our findings provide clear evidence that chronic exposure to air pollution increases the risk for developing obesity,” said Junfeng “Jim” Zhang, a professor of global and environmental health at Duke University and a senior author of the paper.

“If translated and verified in humans, these findings will support the urgent need to reduce air pollution, given the growing burden of obesity in today’s highly polluted world,” Zhang said.

Source:

Duke University