Résumé
@#Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients. Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed. Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery. Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.
Résumé
Background: Dietary advice is the first line treatment for type 2 diabetes [1]. There is research evidence that patients with chronic disease often do not adhere to recommended dietary advice, Desroches et al. [2], however there is limited research investigating dietary adherence amongst individuals with diabetes. The aim of this study was therefore to explore the factors associated with dietary adherence in type 2 diabetes mellitus. Methods: An internet-based qualitative research method was chosen, and following an internet search the ‘Diabetes-Stories’ website, containing verbatim transcripts of open interviews exploring patients’ experiences with diabetes, was selected on the basis of the potential to generate data to meet the aim of the study [3]. The most recent interviews were selected (‘1980s+’) and those involving patients with type 2 diabetes only. Each transcript was then searched using the key words ‘diet’, ‘food’, ‘nutrition’ and ‘dietitian’ to identify data which related to the research aim. Eight interview transcripts were consequently obtained, consisting of interviews with four males and four females, and dating from the years 2004-2007. The data were analysed manually by one researcher using Thematic Analysis. Four emergent themes were reviewed and agreed by the research team. Consent for use of the transcripts was obtained from the website principal investigator and all identifiable information was made anonymous. Results: The four emergent themes were dietary advice and participant understanding participant adaptations and adherence, participant struggles and feelings and relations with healthcare professionals. All participants appeared to understand the dietary treatment of type 2 diabetes and social support and education were reported as important in adherence. Most participants were non-adherent at times and not acknowledging the longer term risks and dislike of the recommended diet were significant reasons. Two participants felt they were not treated as individuals by healthcare professionals and one participant felt he was expected to be more enquiring about treatment decisions than he wanted to be. Discussion: Many studies provide evidence that social support and education are associated with increased diabetes treatment adherence, Gomes-Villas Boas et al, [4]; Minet et al, [5], therefore suggesting their importance in dietetic consultations. In addition to this, studies suggest that providing dietary treatment suited to a patient’s personal circumstances, and preferred delivery of information (prescriptive or inclusive), is also likely to increase adherence (Hancock, 2012). Study limitations include the dates of the transcripts used, and the ‘passive’ analysis of secondary data from a single website. Conclusion: This study provides a useful insight into the factors associated with dietary adherence in type 2 diabetes, and more current ‘active’ qualitative studies are therefore needed to strengthen existing evidence and enable appropriate changes.
Résumé
To assess nutritional adherence to treatment among obese or overweight patients and to examine the relationship between anthropometrical variables, 94 subjects between 20-50 years old randomly selected were recruited at two nutritional health centers in Medellin-Colombia. Nutritional adherence to treatment was evaluated using a questionnaire, with a total score above 24 considered as adherent to the treatment. In addition, socio-demographic information was obtained and anthropometrical variables were measured. We used descriptive statistical, Kolmogorov-Smirnov test, Chi-square for proportions comparison, and Student T test or U Mann Whitney for means comparison. A 68% of the patients were classified as no adherent to the nutritional treatment, with significant differences found according to physical activity (p= 0,013). Mean weight (p= 0,014), BMI (p= 0,026), waist circumference (p= 0,005) and waist-hip ratio (p= 0,022) differed according to adherence, being significantly higher in non adherent patients. Percent body fat did not change by degree of adherence. However when controls were separated by gender the results were significant for both men and women. Nutritional adherence to treatment in patients on a diet for weight reduction produces significant changes in body composition.
Se determinó la adherencia al tratamiento nutricional en pacientes con obesidad o sobrepeso y se examinó la relación entre ésta y variables antropométricas, mediante un estudio transversal en 94 sujetos entre 20 y 50 años seleccionados de forma aleatoria en dos centros de atención nutricional de Medellín. La adherencia al tratamiento nutricional se evaluó aplicando un cuestionario, donde puntajes mayores o iguales a 24 se consideraron como adherentes. Además, se obtuvo información socio-demográfica y antropométrica, previa estandarización de los evaluadores. Se utilizaron medidas descriptivas, prueba de Kolmogorov-Smirnov, Chi-cuadrado para comparación de proporciones, T de Student o U Mann Whitney para comparación de promedios. El 68% de los pacientes fueron clasificados como no adherentes al tratamiento nutricional, encontrando diferencias según actividad física (p=0,013). El peso promedio (p=0,014), Indice de Masa Corporal (p=0,026), perímetro de cintura (p=0,005) y relación cintura cadera (p=0,022), difirieron de acuerdo a la clasificación de adherencia, siendo significativamente más altos en los no adherentes. No hubo diferencias en el porcentaje de masa grasa según adherencia (p=0,690), pero se hallaron al controlar por sexo, p=0,009 mujeres y p=0,026 hombres. La adherencia al tratamiento nutricional en pacientes en dieta para reducir de peso, produce cambios significativos en la composición corporal.