Clinical impact of a 6-week preoperative very low calorie diet on body weight and liver size in morbidly obese patients.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a technically challenging surgical technique when features such as thick abdominal wall and increased liver volume are present. Very low calorie diets in the form of liquid meal replacements given 6 weeks prior to surgery have proven to decrease liver volume. The aim of our study was to assess the effect of a 6-week preoperative low calorie/regular diet on liver volume and body weight in morbidly obese patients. METHODS: A pilot study was carried out in 20 morbidly obese patients with an 800-kcal diet for 6 weeks. They were followed weekly to ensure proper compliance. CT scan was used for determining liver volume every 2 weeks in order to assess the impact of the diet. Baseline values were taken as controls for every patient as tied measures. Statistical analysis was suitable to variable scaling and performed using SPSS v. 20.0. Parametric and non-parametric test for tied measures were done. Any p value lesser than 0.05 or 5% was considered as statistically significant. RESULTS: Twenty patients adhered to the diet intervention for 6 weeks prior to LRYGB. Median ± SD age was 34.5 ± 11.5 years and 17 were female (85%). Heart rate and blood pressure did not vary across the study. Initial median ± SD BMI was 46.02 ± 5.29 kg/m2 (range 38.7-54.8). Repeated and tied measurements across the 6 weeks of treatment within individuals resulted statistically significant for reducing BMI (p < 0.0001). CT scan assessed liver volume initially as a control and in weeks 2, 4 and 6. Parametric and non-parametric assessment for multiple measurements also showed statistical significance among these values (p < 0.0001). Diet tolerability was additionally evaluated with a questionnaire showing more than 80% of acceptability with discrete rates of nausea (15%) and diarrhoea (15%). CONCLUSIONS: Based on our results, we demonstrated that a very low calorie diet with home ingredients is capable for effectively reducing body weight and liver size in morbidly obese patients. This relatively short intervention (4 to 6 weeks) was accomplished in all our patients with a high frequency of compliance and a low rate of secondary effects.

Weight loss and body composition during the first postoperative year of a laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Weight loss in patients undergoing gastric bypass should be primarily from fat mass (FM), minimizing the fat-free mass (FFM) loss. The aim of this study was to analyze changes in body weight and body composition during the first postoperative year in 50 morbidly obese patients undergoing a Laparoscopic Roux-en-Y gastric bypass (LRYGBP) at the Obesity Clinic of the ABC Medical Center. METHODS: Patient's weight and body composition were obtained before surgery and 1 year later using bioelectrical impedance analysis (BIA). Weight, FM, FMM, and total body water (TBW) were measured before and 1 year after surgery. Changes in body composition were particularly analyzed. RESULTS: There were 29 females and 21 males with mean age of 41 +/- 12 years. Mean BMI before surgery and 1 year after surgery was 44.4 +/- 7.4 kg/m(2) and 28.3+/-4.3 kg/m(2), respectively. The percentage of excess body weight loss at the 1-year period was 86% for women and 79.6% for men. The percentage of FM before surgery was 47.7 +/- 5.1, and 1 year later it was 28.8 +/- 8. The percentage of FFM was 66.5 +/- 16.5 before surgery and 58.3 +/- 13 at 1 year. CONCLUSIONS: There is a significant weight loss in patients undergoing LRYGBP. Weight loss mainly occurs as a consequence of reduction in the FM with less impact on the FFM.