Original articleFood tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass
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.
References (24)
- et al.
Surgery for morbid obesity. Using an inflatable gastric band
AORN J
(1990) - et al.
Health behavior, food tolerance, and satisfaction after laparoscopic sleeve gastrectomy
Surg Obes Relat Dis
(2011) - et al.
Relation between changes in neural responsivity and reductions in desire to eat high-calorie foods following gastric bypass surgery
Neuroscience
(2012) - et al.
Surgery for obesity
Cochrane Database Syst Rev
(2009) - et al.
Bariatric surgery: a systematic review and meta-analysis
JAMA
(2004) - et al.
The laparoscopic adjustable gastric band (Lap-Band (R)): a prospective study of medium-term effects on weight, health and quality of life
Obes Surg
(2002) - et al.
The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction
Int J Obes
(2011) - et al.
Hormone changes affecting energy homeostasis after metabolic surgery
Mt Sinai J Med J Transl Pers Med
(2010) - et al.
Gastrointestinal hormones, energy balance and bariatric surgery
Int J Obes
(2011) - et al.
A new questionnaire for quick assessment of food tolerance after bariatric surgery
Obes Surg
(2007)
Effect of different bariatric operations on food tolerance and quality of eating
Obes Surg
Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss
Surg Endosc
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