Contribution of Ultra-Processed Foods to Weight Gain Recurrence 5 Years After Metabolic and Bariatric Surgery.

BACKGROUND: The aim of this study was to evaluate evolution of ultra-processed food intake and recurrent weight gain in patients who underwent Roux-en-Y gastric bypass. MATERIALS AND METHODS: This study is an observational longitudinal study that evaluated patients who underwent metabolic and bariatric surgery at four time points: before surgery and at 3, 12, and 60 months after surgery. Anthropometric and dietary intake data were collected through two 24-h dietary recalls. All foods consumed were classified according to degree of processing. Recurrent weight gain was considered the difference between current weight and nadir weight. RESULTS: The sample consisted of 58 patients with a mean age of 38.7 ± 8.9 years and 68% female. After 60 months, mean excess weight loss and recurrent weight gain were 73.6 ± 27.2% and 22.5 ± 17.4%. Calorie and macronutrient intake decreased significantly between the pre-surgery period, and 3 and 12 months post-surgery; however, there was no significant difference after 60 months. In relation to food groups or macronutrients, no difference was observed between the pre-surgery period and 60 months post-surgery. The contribution of unprocessed or minimally processed foods to calorie intake gradually decreased after 3 months post-surgery. CONCLUSION: The profile of dietary intake after 60 months of metabolic and bariatric surgery tends to approach that of the pre-surgery period. The contribution of unprocessed and minimally processed foods to calorie intake decreased after 60 months, while ultra-processed food contribution increased.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS: NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS: In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION: There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Anxiety and Negative Body Image are Associated with Binge Eating in Patients Who Underwent Bariatric Surgery a Minimum of 2 Years.

PURPOSE: Bariatric surgery is an effective method for the treatment of severe obesity, however, binge eating disorder (BED) and negative body image can interfere with post-surgical evolution. OBJECTIVE: To describe the factors associated with BED in bariatric patients with a minimum of 2 years post-surgery. MATERIALS AND METHODS: A cross-sectional observational study conducted with patients who underwent bariatric surgery through the Unified Health System (Sistema Único de Saúde [SUS]) and presenting a minimum of 2 years post-surgery. BED, depression symptoms, anxiety symptoms, quality of life and body image concerns were assessed by the Binge Eating Scale, Beck Depression Inventory, Beck Anxiety Inventory, Bariatric Analysis and Reporting Outcome System, and Body Shape Questionnaire, respectively. Socioeconomic and anthropometric data were also collected. RESULTS: Based on the ninety-two (92) patients evaluated, 83.7% were female, and had a mean age of 43.3 ± 9 years. Symptoms of depression (p = 0.002), anxiety (p = 0.000), body image concerns (p = 0.000), poor quality of life (p = 0.010), and obesity (p = 0.008) were associated with the presence of BED. All the anthropometric variables were higher in patients with BED, except excess weight loss. Regression analysis predicted BED through the presence of body image concern and anxiety symptoms. CONCLUSION: Anxiety symptoms and body image concerns are associated with BED in patients who underwent bariatric surgery a minimum of 2 years.

Food Consumption and Weight Recurrence in Patients Undergoing Bariatric Surgery with a Minimum of 2 Years Post-surgery.

BACKGROUND: Eating habits are one of the factors that directly affect weight recurrence after bariatric surgery, and therefore, this study assessed the association between food consumption and weight recurrence in patients who underwent bariatric surgery a minimum of 2 years. METHODS: A cross-sectional observational study was conducted with patients who underwent bariatric surgery a minimum of 2 years through SUS, in the city of Palmas, Tocantins. Food consumption was assessed through two 24-h dietary recalls (R24). The foods were classified into groups by degree of processing following the NOVA classification system. Also, macronutrients and fiber contents were quantified. Anthropometric variables were evaluated and weight recurrence (WR) was defined as 15%. RESULTS: Ninety-three (93) patients participated in the study, being 83.9% female, with mean age of 43.5 ± 9.13 years, mean post-surgery time of 4 years, and 58% present WR. A lower total energy consumption was found in patients without WR compared to those with WR (p = 0.05). Among the WR group, calories from processed foods (p = 0.00) and culinary ingredients (p = 0.05) were higher. However, carbohydrate consumption (percentage) was lower in the WR group (p = 0.04). A positive correlation was found between total energy (p = 0.03), processed foods (p = 0.03) and weight recurrence (p = 0.03). CONCLUSION: Weight recurrence is associated with total daily energy intake, carbohydrates and food groups classified according to NOVA.

Preoperative Carbohydrate Quality Index Is Related to Markers of Glucose Metabolism 12 Months After Roux-en-Y Gastric Bypass.

OBJECTIVE: The role of carbohydrates in weight loss in patients undergoing bariatric surgery (BS) remains poorly understood. Therefore, this study aimed to verify the relationship of the carbohydrate quality index (CQI) with weight loss and cardiometabolic risk markers up to 1 year after BS. MATERIAL AND METHODS: This study included 50 patients with obesity undergoing Roux-en-Y gastric bypass. Data collection was performed preoperatively and 3 and 12 months after surgery. The foods consumed were documented using a 24-h food recall in 3 days. The CQI was calculated considering the following parameters: dietary fiber intake, sugar level; whole grains: proportion of total grains; solid carbohydrate: total carbohydrate ratio. RESULTS: From the total study sample, 58 participants were followed up for 3 months, and eight participants dropped out of the study. The remaining 50 patients were followed up for 12 months. Subjects were classified into tertiles according to the index score. A 1-unit increase in CQI was associated with a -1.02 decrease in insulin concentrations at 12 months and a -1.04 decrease in HOMA-IR. Concerning the total sample, the median of the CQI was 8 points and did not change at 3 and 12 months after surgery, but there was an improvement in some components of the index. CONCLUSION: The data suggest that the quality of carbohydrates can interfere with markers of insulin resistance after BS and the quality of carbohydrates is a point to be guided in patients undergoing BS.

Animal Protein Intake Is Associated with Obesity Remission After Roux-en-Y Gastric Bypass: an Isocaloric Replacement Analysis.

PURPOSE: Some patients do not have the expected weight loss, and the post-surgical diet may partially explain these differences. OBJECTIVES: To estimate the impact of macronutrient substitution on obesity remission after RYGB, considering the protein source. MATERIALS AND METHODS: This study included 58 patients undergoing RYGB. Data collection was performed preoperatively, 3 and 12 months after surgery. Eight participants dropped out of the study at 3 months, and the others remained for 12 months. The foods consumed were registered using a 24-h, 3-day food recall. For the isocaloric substitution analysis, foods were classified according to the protein source. The groups were compared using hypothesis tests, and Cox proportional hazard ratio regression was used to analyze isocaloric substitution. RESULTS: At three months after surgery, every 5% energy from plant protein replaced by animal protein increased by 3.50 [CI 1.204 - 10.205; p = 0.021] the probability of obesity remission. Stratified analysis by protein groups indicated that replacing vegetable protein with white meat was positively associated with remission of obesity. Every 5% vegetable protein replaced with white meat increased by 3.20 [CI 1.026 - 9.981; p = 0.045] the probability of obesity remission. Both results were independent of age, body mass index (BMI), and the presence of comorbidities. CONCLUSION: The results suggest that the consumption of animal proteins after RYGB, mainly white meat, favors weight loss.

Influence of dietary patterns on the metabolically healthy obesity phenotype: A systematic review.

AIMS: In many individuals (35%) obesity is not accompanied by cardiometabolic disorders, a condition referred to as metabolically healthy obesity. Since the effectiveness of dietary interventions for this condition is not well established, this study reviews the influence of dietary patterns on the phenotype of metabolically healthy obesity in adults and elderly. DATA SYNTHESIS: The review was carried out following the PRISMA guidelines and registered in the PROSPERO. The search was conducted in the MEDLINE, SCOPUS, Web of Science, Science Direct, LILACS, and SciELO databases. A total of 236 articles were identified, seven of which were selected for synthesis after application of the eligibility criteria. CONCLUSIONS: The overall result found out in this synthesis was that the greater adherence to healthy eating patterns was considered a preventive to the transition from metabolically healthy obesity to metabolic unhealthy obese phenotypes, by improving metabolic health, and reducing the risk of cardiovascular disease and mortality from all causes. In contrast, unhealthy eating patterns resulted in increased inflammation and risks of developing noncommunicable diseases. This review indicates that adherence to healthy eating patterns may interfere with metabolic phenotypes of obesity and positively affect metabolically healthy obesity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42020159783.

The Preoperative Dietary Inflammatory Index Predicts Changes in Cardiometabolic Risk Factors After 12 Months of Roux-en-Y Gastric Bypass.

BACKGROUND: The objective of this study was to evaluate Dietary Inflammatory Index (DII®) in the preoperative period as well as 3 and 12 months post-surgery and its association with cardiometabolic risk factors after RYGB. MATERIALS AND METHODS: This is a prospective cohort study of 50 patients (both sexes) who underwent RYGB. All data were collected in 3 phases: before surgery, 3, and 12 months post-surgery. To calculate DII scores, we utilized mean nutrients from three 24-h recalls at each time point. RESULTS: The patients had median age of 39.1 ± 7.9 years (70% women). Mean preoperative DII® score of 0.39 ± 1.49 was slightly pro-inflammatory. Mean DII score reduced to - 1.52 ± 1.27 after 3 months post-surgery and was classified anti-inflammatory. This value rebounded to - 0.88 ± 1.49 at 12 months but was still anti-inflammatory. From the adjusted linear regression analysis, we observed that preoperative DII score was statistically associated with variations in neck circumference (ß = - 0.50; p = 0.03), waist-hip ratio (ß = 0.01; p = 0.02), total cholesterol (ß = 6.47; p = 0.002), and LDL cholesterol (ß = 6.42; p = 0.001) after 12 months post-surgery. Changes in DII® at 3 and 12 months were not associated with changes in cardiometabolic risk factors. CONCLUSION: We observe significant changes in the inflammation potential of diet after 3 and 12 months of RYGB. Patients with higher preoperative E-DII scores have a greater metabolic improvement after 12 months of surgery.