A Follow-up Study Of Metabolic Surgery In Obese Patients

Chapter 1 Six months dietary investigation on obese patients following metabolic surgeryObjective: To evaluate the dietary changes and safety of obese adults 6 months after metabolic surgery.Methods:Thirty-eight adult obese patients who underwent metabolic surgery in Nanjing Drum Tower Hospital from January to July2019 and were followed up for 6months after surgery were selected.A 3-day,24-hour diet survey was conducted before and after the surgery combined with lifestyle questionnaire,human body composition and metabolic index detection.Results:(1)Changes in energy intake and caloric distribution of three meals: 97.4%obese patients had excessive daily energy intake before surgery,with an average of(2339.2±537.3)kcal;The breakfast calories were lower than the recommended value and the caloric proportion was 21.6(15.6,26.1)%.1,3 and 6 months after surgery,patients' energy intake decreased compared with baseline(P<0.05),the daily energy intake was(850.5±216.8)kcal at 6 months,which was significantly higher than that at1 and 3 months(P<0.05);Postoperative the energy supply ratio of lunch and dinner decreased and additional meals increased compared with baseline(P<0.05).(2)Changes in the intake and energy supply ratio of the three major nutrients: Before surgery the protein and fat intake and energy supply ratio were higher than the recommended values,while the carbohydrate intake was reasonable and the energy supply ratio was low.After surgery,the intake of all the three nutrients decreased,the carbohydrate energy supply ratio decreased while the protein and fat increased(P<0.05).Combined with calorific calorie,the patient's diet was very low energy or low energy,low carbohydrate and high protein diet.(3)Changes in nutrient intake:The intake of calcium,folic acid,vitamin B6 and vitamin B12 in obese patients is lower than recommended.1,3,and 6 months after surgery,the intake of all vitamins and minerals except vitamin B12 decreased from baseline(P<0.05);Six months after surgery,all vitamin and mineral intakes did not reach the recommended levels.(4)Body composition and metabolic index changes: After surgery,the patient's weight was reduced(P<0.05),body composition,glucolipid metabolism,liver function,uric acid,bone metabolism were all improved relative to their preoperative status(P<0.05).Conclusion:Before the metabolic surgery,the intake of energy,protein and fat in adult obese patients exceeded the standard and the intake of nutrients was insufficient.After surgery,the energy and carbohydrate intake of the patients were all below the recommended value;patients were on an extremely low-energy,low-carbohydrate and high-protein diet within 3 months after the surgery,and a low-energy,low-carbohydrate and high-protein diet 6 months after surgery.The results of human body composition and metabolic index of the patients suggested that the diet changes in 6 months after the surgery were safe and effective in reducing weight and improving metabolic disorders.The deficiency of dietary nutrients in the short term after the surgery suggests that it should be supplemented in time under effective monitoring to prevent the occurrence of nutrition-related complications.Chapter 2 A follow-up study of metabolic surgery in obese adolescentsObjective: To investigate the safety and efficacy of metabolic surgery in obese adolescents.Methods:Seventeen adolescents(aged 13-19 years)underwent metabolic surgery in Nanjing Drum Tower Hospital between Nov.2015 and Jan.2019 were recruited.Lifestyle,body composition,metabolic indicators and complications were assessed before and 6 month after surgery.Results:6 months after metabolic surgery,patient's eating speed was slower,and proportion of gluttony,fried food and fast food decreased compared to baseline(P<0.05).The average sedentary time and the exercise frequency decreased(P<0.05).Body weight,body weight index(BMI),waist circumference,waist-hip ratio,percentage of body fat,body fat and blood pressure of the patients at 6 months after surgery were lower than those at baseline(P<0.01).Glucolipid metabolism,liver and kidney function,uric acid were all improved relative to their preoperative status(P<0.05)and the indexes of anemia and iron metabolism were stable.Improvement of nonalcoholic fatty liver disease,hyperuricemia,abnormal glucose tolerance and other obesity related complications were clarified in the patients after surgery(P<0.05).No patients had surgical-related complications such as conversion to laparotomy or death.Conclusion:Metabolic surgery changes the unhealthy lifestyle of moderately and severely obese adolescents,results in safe and effective weight loss,improvement of body composition parameters and alleviated obesity-related metabolic disorders and complications.In the short term,metabolic surgery is beneficial for moderately and severely obese adolescents.The multidisciplinary team of metabolic surgery helps to ensure the safety of surgery and effective follow-up.