Nutritional guidance, monitoring, and supplementation before and after bariatric surgery - Are we doing this correctly? / Orientación, seguimiento y suplementación nutricional antes y después de la cirugía bariátrica: ¿lo estamos haciendo correctamente?

Background and aims: minimizing nutritional depletions after a Roux-en-Y gastric bypass (RYGB) may improve clinical results in the treatment of obesity. We evaluated nutritional aspects of obese women undergoing RYGB at a reference university hospital with a department specialized in bariatric surgery. Method: based on the Dietary Reference Intakes developed by the Food and Nutrition Council, Institute of Medicine, and the guidelines issued by the American Society for Metabolic and Bariatric Surgery, we assessed the quantitative and qualitative adequacy of nutritional intake, supplementation, and biochemical monitoring of 20 women both before and 3 and 12 months after a RYGB. Data on nutritional intake was obtained by applying different food surveys, quantitatively interpreted by the Virtual Nutri Plus® software and using reference nutritional databases. Results: nutritional intake deficits were already found before the RYGB (p ≤ 0.05). These worsened postoperatively (p ≤ 0.05), a period also marked by a qualitatively poor diet. The nutritional supplementation prescribed did not fully achieve the reference recommendations, and was poorly complied with by patients. Furthermore, nutritional monitoring was not carried out in all patients, recommended biochemical markers were not screened, and vitamin D depletions occurred. (AU)

Antecedentes y objetivos: minimizar el deterioro nutricional después del baipás gástrico en Y de Roux (BGYR) puede mejorar los resultados clínicos en el tratamiento de la obesidad. Se evaluaron aspectos nutricionales de mujeres obesas sometidas a BGYR en un hospital universitario de referencia con servicio especializado de cirugía bariátrica. Método: con base en la Ingesta Dietética de Referencia desarrollada por el Consejo de Alimentos y Nutrición del Instituto de Medicina, y las directrices de la Sociedad Estadounidense de Cirugía Bariátrica y Metabólica, evaluamos la adecuación cuantitativa y cualitativa de la ingesta nutricional, la suplementación y el seguimiento bioquímico de 20 mujeres tanto antes como 3 y 12 meses después de un BGYR. Los datos de la ingesta nutricional se obtuvieron mediante la aplicación de diferentes encuestas alimentarias, interpretadas cuantitativamente por el software Virtual Nutri Plus® y utilizando bases de datos nutricionales de referencia. Resultados: se encontraron déficits de ingesta nutricional antes del BGYR (p < 0,05). Estos empeoraron en el postoperatorio (p < 0,05), período también marcado por una mala alimentación cualitativa. La suplementación nutricional prescrita no cumplió plenamente con las recomendaciones de referencia y no fue bien cumplida por los pacientes. Además, la monitorización nutricional no se aplicó en todos los pacientes y no se examinaron todos los marcadores bioquímicos recomendados, hallándose depleciones de vitamina D. (AU)

Comparison of Virtual Nutri Plus® and Dietpro 5i® software systems for the assessment of nutrient intake before and after Roux-en-Y gastric bypass.

OBJECTIVES: The assessment of nutritional intake before and after bariatric surgery assists in identifying eating disorders, nutritional deficiencies and weight loss/maintenance. The 7-day record is the gold standard for such an assessment and is interpreted using specialized software. This study sought to compare the Virtual Nutri Plus® and Dietpro 5i® software systems in assessing nutrient intake in obese patients with type 2 diabetes mellitus who underwent a Roux-en-Y gastric bypass. METHODS: Nutritional intake was assessed in 10 obese women with type 2 diabetes mellitus before and 3 months after Roux-en-Y gastric bypass. The 7-day record was used to assess food intake and then, the Virtual Nutri Plus® and Dietpro 5i® software systems were used to calculate calorie, macronutrient and micronutrient intake based on validated food chemical composition databases. Clinicaltrials.gov: NCT01251016. RESULTS: During the preoperative period, deficits in the ingestion of total fiber and 15 out of 22 estimated micronutrients were observed when using the Virtual Nutri Plus®, compared to deficiencies in total fiber and 4 micronutrients when using the Dietpro 5i®. During the postoperative period, both the Virtual Nutri Plus® and Dietpro 5i® systems detected deficits in the ingestion of total fiber, carbohydrates and 19 micronutrients, but only the Virtual Nutri Plus® detected deficits in complex B vitamins (except B12) and minerals. CONCLUSION: Virtual Nutri Plus® was more sensitive than Dietpro 5i® for the identification of deficits in nutrient intake in obese, type 2 diabetes mellitus patients undergoing Roux-en-Y gastric bypass.

Efficiency of the 24-hour food recall instrument for assessing nutrient intake before and after Roux-en-Y gastric bypass / Eficacia del instrumento de recordatorio de comidas de 24 horas para la evaluación de la ingesta de nutrientes antes y después de bypass gástrico en Y de Roux

Background: Nutritional and food intake assessments before and after bariatric surgery may be important to correct eating habits and nutritional deficiencies. Aim: To assess the efficiency of the 24-hour food recall (24hR) form as a fast method for assessing nutrient intake before and after a Roux-en-Y gastric bypass (RYGB). Methods: This study analyzed data from 10 obese patients with type 2 diabetes mellitus (T2DM). Food intake (calories, macronutrients, and micronutrients) before and 3 months after RYGB were assessed with the 24hR as well as the seven-day food record (7dR) as the gold standard reference. Virtual Nutri Plus® software was used to quantify nutrients. Results: The 7dR data revealed deficits in the estimated intake of total fiber and 14 out of 22 micronutrients pre- and postoperatively, combined; the 24hR failed to detect intake deficits in only two of these micronutrients (vitamins A and B3). Other postoperative deficits included carbohydrates, vitamin B1, copper, and iron, on which the 24hR was sensitive to only the iron deficit. In our pre- versus post-operative comparison analyses, the 7dR revealed decreases in total calories, carbohydrates, total and all subclasses of fat and fiber, and 12 micronutrients; in the analogous comparison analyses, the 24hR failed to detect decreases in the ingestion of monounsaturated and saturated fats and in six of these micronutrients. Conclusions: In obese T2DM patients, the 24hR performed reasonably well for probing nutrient intake before and after RYGB, but is not recommended for tracking changes over time, including pre- versus postoperative deficits (AU)

Introducción: Las evaluaciones nutricionales y de ingesta de comida antes y después de cirugía bariátrica puede ser importante para corregir hábitos de alimentación y deficiencias nutricionales. Objetivo: Evaluar la eficacia del formulario de recordatorio de alimento de 24 horas (24hR) como método rápido de evaluación de ingesta de nutrientes antes y después de bypass gástrico en Y de Roux (RYGB). Métodos: Este estudio analizó datos de 10 pacientes obesos con diabetes mellitus de tipo 2 (T2DM). Se evaluó la ingesta de alimentos (calorías, macronutrientes y micronutrientes) antes y 3 meses después de RYGB con el 24hR además del registro de alimentos de siete días (7dR) como patrón de referencia estándar. Se utilizó el software Virtual Nutri Plus® para cuantificar los nutrientes. Resultados: Los datos del 7dR revelaron deficiencias en la ingesta estimada de fibra total y 14 de 22 micronutrientes pre- y postoperación, combinados; el 24hR no pudo detectar deficiencias de ingesta en solo dos de estos micronutrientes (vitaminas A y B3). Otras deficiencias postoperatorias incluyeron carbohidratos, vitamina B1, cobre y hierro, sobre las que el 24hR detectó solo la deficiencia de hierro. En nuestros análisis comparativos pre- y post-operación, el 7dR reveló descensos en calorías totales, carbohidratos, grasas totales y todas las subclasses de grasa y fibra, y 12 micronutrientes; en los análisis comparativos análogos, el 24hR no logró detectar descensos en la ingesta de grasas monoinsaturadas y saturadas y en seis de estos micronutrientes. Conclusiones: En pacientes obesos con T2DM, el 24hR funcionó razonablemente bien demostrando la ingesta de nutrientes antes y después de RYGB, pero no se recomienda para registrar cambios a lo largo del tiempo, incluyendo deficiencias pre- y postoperación (AU)

Comparison of Virtual Nutri Plus® and Dietpro 5i® software systems for the assessment of nutrient intake before and after Roux-en-Y gastric bypass

OBJECTIVES: The assessment of nutritional intake before and after bariatric surgery assists in identifying eating disorders, nutritional deficiencies and weight loss/maintenance. The 7-day record is the gold standard for such an assessment and is interpreted using specialized software. This study sought to compare the Virtual Nutri Plus® and Dietpro 5i® software systems in assessing nutrient intake in obese patients with type 2 diabetes mellitus who underwent a Roux-en-Y gastric bypass. METHODS: Nutritional intake was assessed in 10 obese women with type 2 diabetes mellitus before and 3 months after Roux-en-Y gastric bypass. The 7-day record was used to assess food intake and then, the Virtual Nutri Plus® and Dietpro 5i® software systems were used to calculate calorie, macronutrient and micronutrient intake based on validated food chemical composition databases. Clinicaltrials.gov: NCT01251016. RESULTS: During the preoperative period, deficits in the ingestion of total fiber and 15 out of 22 estimated micronutrients were observed when using the Virtual Nutri Plus®, compared to deficiencies in total fiber and 4 micronutrients when using the Dietpro 5i®. During the postoperative period, both the Virtual Nutri Plus® and Dietpro 5i® systems detected deficits in the ingestion of total fiber, carbohydrates and 19 micronutrients, but only the Virtual Nutri Plus® detected deficits in complex B vitamins (except B12) and minerals. CONCLUSION: Virtual Nutri Plus® was more sensitive than Dietpro 5i® for the identification of deficits in nutrient intake in obese, type 2 diabetes mellitus patients undergoing Roux-en-Y gastric bypass. .