| BackgroundObesity,which has been recognized as a disease by the World Health Organization,is threatening great damages to humans’ health.And active prevention as well as treatment of obesity and the comorbidities have attracted widespread attention.Metabolic surgery can bring human the benefit of profound weight loss and the improvement of the obesity-related comorbidities by reconstructing the gastrointestinal tract and then reducing food intake and(or)absorption of nutrients.At present,metabolic surgery has become the most effective treatment for severely obese patients.After metabolic surgery,changes in weight and body mass index are commonly used to evaluate the outcome of surgery,but these can not accurately reflect the changes in other body composition such as fat mass(FM),lean body mass(LBM)or fat free mass(FFM).With the development and application of body composition analysis,exploring the body composition changes after metabolic surgery from different levels,thus more scientifically guiding postoperative management strategies such as diet and exercise,has become an important hot issue under researching.For patients during the early postoperative time,the stress of the surgery along with the drastic reduction of food intake may lead to the loss of LBM or FFM.LBM or FFM is important indicator reflecting the nutritional status of the body,both of which contain an important component of skeletal muscle mass(SMM).The loss ofSMM may negatively affect the glycaemic regulation,physical function,resting metabolic expenditure,then impairing the patient’s long-term weight loss and quality of life.Actively exploring the influencing factors of LBM loss or FFM loss can provide guidance for targeted interventions in the preservation of LBM or FFM,thereby optimizing the long-term outcome of surgery.Nowadays,there is less domestic research evaluating the influencing factors of LBM loss or FFM loss;foreign focus on protein intake,physical activity,type of surgery and other factors but there are still conflicting results between these existing studies.Therefore,it is necessary to further explore the body composition changes of Chinese population undergoing metabolic surgery in the early stage postoperatively,and clarify the influencing factors of LBM loss or FFM loss in the population,thus providing some supporting evidence for forming the preservation strategies of FFM or LBM.Objectives1.To investigate the body composition changes of patients undergoing metabolic surgery during the early postoperative stage.2.To identify the influencing factors of LBM loss or FFM loss after metabolic surgery.MethodsA perspective study including 110 patients was conducted from May 2017 to February 2018 at the Department of Bariatric and Metabolic Surgery in the first Affiliated Hospital of Nanjing Medical University.The basic information such as age,gender,and education level of the patients,as well as the clinical information including the height,weight and type of surgery were collected.24-hour food recall and the International Physical Activity Questionnaire(long form)were used at 1month after surgery to investigate the patient’s diet and physical activity.Bodycomposition was measured using bio-electrical impedance analysis at baseline and one month postoperatively.Changes in weight、body mass index、the whole body as well as segmental FM and LBM were examined.Univariate analysis,correlation analysis and multiple linear regression analysis were used to identify the influencing factors of the percentage of LBM loss(LBML%)or FFM loss(FFML%).Results1.One month after surgery,the total weight loss,BMI,LBM,FM,percentage of FM(FM%)all significantly decreased(P?0.05),with percentage of excess weight loss(EWL%)by(36.78±14.09)%,LBML% by(43.74±13.11)%,FFML% by(45.74±14.40)%.The serum albumin level was(46.29±3.29)g/L one month postoperatively.2.Compared to baseline,FM and LBM of the upper limbs、trunk and the lower limbs significantly decreased(P?0.05).The LBM loss of the trunk was greater than the lower limbs,which was followed by upper limbs(P?0.05);the FM loss of the trunk was greater than the limbs(P?0.05),meanwhile there was more FM loss in upper limbs than lower limbs.3.Physical activity results showed that 52.08% of the 96 patients resume working during the first one month after surgery;the rate of patients walking and doing moderate-intensity physical activities in leisure time was 56.25% and 31.25%;According to the International Physical Activity Questionnaire protocol,39(40.6%)patients were in low physical activity level,46(47.9%)in moderate level and 11(11.5%)in high level.Food recall showed that the patients consumed calorie of[250.00(150.00,300.00)]kcal/d.Besides,90(93.75%)patients’ protein intake was less than 60 g per day while only 6(6.25%)was equivalent to or more than 60 g.For the 96 patients who consumed protein powder,20(20.83%)had protein powder for 5or less than 5 days while 76(79.17%)had over 5 days a month.4.During the first postoperative month,univariate analysis revealed thatLBML% and FFML% were significantly different between the two types of surgery(P<0.05).The correlation analysis showed that LBML% was negatively related with the type of surgery and positively with weight loss(r =-0.243,P<0.05;r =0.339,P<0.05);And the relationship between FFML% and the type of surgery、FFML%and weight loss were the same as LBML%(r =-0.223,P<0.05;r =0.294,P<0.05).Multiple linear regression analysis found that type of surgery and weight loss(P<0.05)were significantly linked with LBML% as well as FFML% at 1 month after the operation.Conclusions1.At one month after surgery,the patient’s EWL% was higher than that of the relevant study results;the patient’s serum albumin was within the normal range while the LBML% and FFML% accounted for about half of the body weight loss,which needs attention.The FM and LBM of the upper limbs、trunk and the lower limbs significantly decreased with the most noticeable changes in the trunk.2.Only about half of the population went to work and their participation in daily exercise was inactive.Food tolerance and other factors restricted the patients’ intake of protein as well as calorie.And protein powder was an important source of protein.In addition,type of surgery and weight loss were the influencing factors of LBML% and FFML%,eliciting that the purely restrictive procedure and more weight loss may do damage to the preservation of LBM/FFM.The relationship between LBML%/FFML% and other variables(eg: amount of protein intake 、 physical activity 、gender、age)remains to be further explored in the future. |
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