Elsevier

Obesity Research & Clinical Practice

Volume 8, Issue 2, March–April 2014, Pages e183-e191
Obesity Research & Clinical Practice

Original article
Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass

https://doi.org/10.1016/j.orcp.2013.02.002Get rights and content

Summary

Objective

The effects of food tolerance (if any) on diet quality several years post-surgery remain unclear. Our study aimed to assess food tolerance and diet quality after three bariatric procedures; adjustable gastric banding (AGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP), 2–4 years post-surgery.

Methods

This prospective, cross-sectional study assessed weight loss, food tolerance and diet quality in 130 subjects (14 obese pre-surgical controls, 13 AGB, 62 SG and 41 RYGBP). Inclusion criteria selected patients who underwent bariatric surgery between 1 January 2007 and 31 December 2008, at a single bariatric clinic. Non-parametric tests (Kruksal–Wallis and Mann–Whitney) along with Spearman's correlation coefficient analysis were used.

Results

Superior food tolerance was reported by the control (24.5), SG (24.0) and RYGBP (22.0) groups, compared with the AGB group (15.5; P < 0.001). The control and AGB groups consumed significantly more high-calorie extra foods (9.2 and 7.7 daily serves respectively) compared with the SG (3.4 serves) and RYGBP (4.0 serves) groups. There were several significant correlations between food tolerance and dietary intake including breads and cereals and meat and meat alternatives.

Conclusion

The control and AGB groups consumed significantly more high-calorie extra foods, a result that was paralleled by poor weight loss and food tolerance outcomes for the AGB group. A significant positive relationship between food tolerance and diet quality was established. Poor food tolerance and thus compromised diet quality need to be considered as post-surgical complications of the AGB procedure.

Introduction

Bariatric surgery is an effective tool for weight loss in morbidly obese patients [1], [2]. Adjustable gastric banding (AGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) differ in technique, anatomical configuration and their mode of action [1]. AGB procedure involves an adjustable band placed high on the stomach, distal to the cardio esophageal junction, and creating a virtual pouch [3], [4]. Considered a restrictive procedure, AGB has also been illustrated to induce satiety as a mechanism for weight loss [5]. The SG is a restrictive procedure with resection of approximately 80% of the greater curvature of the stomach resulting in a ‘sleeve’ shaped stomach with reduced gastric volume. Furthermore hormonal changes including reduced ghrelin secretion following the fundectomy, and an increase in hindgut satiety hormones (PYY and GLP-1) secondary to the increased rate of gastric emptying [6], are also suggested mechanisms for action. The mechanisms for weight loss in RYGBP are a reduced stomach capacity restricting food intake and gastrointestinal hormonal changes similar to the SG, which have been documented to reduce appetite [7].

Percentage excess weight loss (%EWL) is commonly used for reporting weight loss after bariatric surgery. Other frequently used success markers include co-morbidity improvement and quality of life outcomes. While these are important parameters to consider, food tolerance and diet quality are also particularly important to assess as their outcomes may influence co-morbidities and quality of life. Suter et al. [8] suggest good food tolerance is the ability to consume a variety of foods without difficulty, and with minimal regurgitation/vomiting. Several studies have examined food tolerance following bariatric surgery [8], [9], [10], [11], including an article by Overs et al. [12] which reports on the food tolerance experienced in the same population sample as the current study. These studies show that food tolerance outcomes differ with surgical type and time since surgery [8], [9]. The literature to date reveals the AGB procedure results in a significantly lower total food tolerance score compared with other bariatric procedures [8], [9], [13].

Poor food tolerance is expected early after surgery, however if persistent, may lead to food avoidance or maladaptive eating behaviours [14], [15]. This may result in eating habits that affect overall diet quality, increasing a patient's risk for nutritional deficiencies and compromise weight loss. Previous research has identified dietary and nutrition issues in post-surgical patients [16]. However to the authors knowledge, no studies to date have reported on the effect food tolerance (if any) exhibits on the consumption of the core food groups and overall quality of diet, after bariatric surgery. The aim of this study was to assess food tolerance and diet quality in AGB, SG and RYGBP patients 2–4 years post-surgery, comparing findings with an obese control group. A secondary aim was to assess whether there is an association between food tolerance and diet quality in these patients.

Section snippets

Study design

This study was conducted as part of a larger study investigating several outcomes at a time point of 2–4 years post-surgery [12]. Ethics were approved by the University of Wollongong/South Eastern Sydney and Illawarra Area Health Service Human Research Ethics Committee in August 2010.

Recruitment took place from a single clinic in Sydney in August and September 2010. Invitation packages were mailed to all patients who had undergone bariatric surgery by a single surgeon between 1 January 2007 and

Study population

The characteristics of the study population are presented in Table 1. A higher proportion of the study was made up by women (67.7%). The RYGBP patients were significantly older than both the control (P = 0.007) and the SG groups (P < 0.001). The median time since surgery differed significantly between the RYGBP and the SG groups (34.0 and 26.5 months respectively; P = 0.003).

There were no significant differences between the pre-surgical BMIs of the four study groups. The post-surgical BMI of the AGB

Discussion

This study showed that the SG and RYGBP patients experienced significantly better food tolerance compared to the AGB group. These superior results for the SG and RYGBP patients were complemented by significantly greater %EWL and a diet that contained significantly less high-calorie extras, compared to both the AGB and the control groups. Our results indicate that the consumption of breads and cereals as well as meat and meat alternatives increases with improved tolerance 2–4 years post-surgery.

Conclusion

This study demonstrates the AGB procedure is inferior for weight loss and food tolerance outcomes. It also demonstrates that diet quality is associated with food tolerance. It illustrates that reduced food tolerance and poor diet quality need to be considered as possible complications of the AGB procedure.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding source

St. George Upper GI Clinic.

Acknowledgement

We would like to thank Dr. Marijka Batterham (BSc (Biochem), MSc (Nutr & Diet), MMedStat, PhD, AdvAPD) at the University of Wollongong for her statistical guidance in this project.

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      However, there was more inadequate intake of B12, B1, zinc and iron in the surgical versus the non-surgical group (De Torres Rossi et al., 2012). Furthermore, AGB group had the lowest food tolerance and highest frequency of vomiting and regurgitation, this was complemented by a significantly lower %EWL to the other surgical groups (Freeman et al., 2014). On the other hand, Ernst, Thurnheer, Wilms, and Schultes (2009), comparing GBP (mean 78.9 months post-operative) and AGB (mean 22.7 months post-operative) patients, to obese and non-obese controls found that GBP patients ate more poultry, fish, cooked vegetables and eggs, less chocolate, cake, cookies, biscuits and soda and the AGB patients ate more poultry and fish, less pasta, fruit, white bread and toast than the obese controls.

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