Clinical ScienceA short-duration restrictive diet reduces visceral adiposity in the morbidly obese surgical patient
Section snippets
Patients and Methods
After obtaining institutional Institutional Review Board approval, 40 adult patients who met criteria for bariatric surgery at a single institution were enrolled in the study. All patients provided signed informed consent before enrolling in the study. All patients were required to have multiple documented attempts at weight loss, pass a psychological evaluation, and meet with a registered dietician before being scheduled for surgery.
Fourteen days before their bariatric procedure, the patients
Results
Of the 40 patients, 37 (92%) were female; 19 (47%) were Caucasian, 11 (27%) were African-American, 9 (22%) were Hispanic, and 1 (2%) was Asian. The mean age was 37.5-year old, whereas the mean BMI was 42.7(kg/m2; 35.3 to 55.3 kg/m2). The average initial body fat percentage was 50.36% (43.1% to 57.7%). There was no correlation between initial BMI and the preoperative visceral adiposity volume.
Of the 40 patients, 38 (95%) lost weight on the restrictive diet. There was a mean loss of 5.2 lbs
Comments
This study demonstrates that patients on a short preoperative diet have a reduction in visceral adiposity. As the number of surgeries in the morbidly obese increase, surgeons will need to seek measures to reduce complication rates in this challenging population. Even a moderate reduction in visceral adiposity could be beneficial, as increasing visceral adiposity is associated with increased operating times, signifying more complexity associated with the operation. Although a reduction of 7.76 cm
Study Limitations
There are several limitations to this study. This population consisted of mostly young, otherwise healthy females and may not adequately represent the patient population undergoing other complex laparoscopic intestinal surgeries, such as laparoscopic colectomy for diverticular disease. Although there was no statistically significant difference concerning gender or age with regard to weight loss or mesenteric volume loss, there were few males and few patients over the age of 50 years in this
Conclusions
A brief preoperative calorie restricting diet is well tolerated and results in a reduction in visceral adiposity. The clinical significance of these findings requires further investigation.
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ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery
2021, Surgery for Obesity and Related DiseasesCitation Excerpt :Changes in body composition due to preoperative weight loss show a decrease in both fat mass and fat-free mass [65]. Although a few studies observed higher loss of fat-free mass versus fat mass during caloric restriction [76,77], more demonstrate decrease in fat mass greater than fat-free mass [70,71,78–82]. The primary goal of reducing liver volume or size is to provide better exposure of the stomach and to potentially avoid conversion to laparotomy [76].
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There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.