Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study

Hypothesis: A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes. Design: Multicenter, randomized, single-blind study. Setting: Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium. Patients: Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010. Intervention: Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group). Main Outcome Measures: Operating time, surgeon's perceived difficulty of the operation, liver lacerations, intraoperative bleeding and complications, 30-day weight loss, and morbidity. Results: Mean (SD) preoperative weight change was -4.9 (3.6) kg in the VLCD group vs -0.4 (3.2) kg in the control group (P < .001). Although the surgeon's perceived difficulty of the procedure was lower in the VLCD group (median [interquartile range], 26 [15-42] vs 35 [18-50] mm on a visual analog scale; P = .04), no differences were found regarding mean (SD) operating time (81 [21] vs 80 [23] min; P = .53), estimated blood loss (P = .62), or intraoperative complications (P = .88). At the 30-day follow-up, the number of complications was greater in the control compared with the VLCD group (18 vs 8; P = .04). Conclusions: Although weight reduction with a 14-day VLCD regimen before laparoscopic gastric bypass performed in high-volume centers seems to reduce the perceived difficulty of the procedure, only minor effects on operating time, intraoperative complications, and short-term weight loss could be expected. However, the finding of reduced postoperative complication rates suggests that such a regimen should be recommended before bariatric surgery

Safety of bariatric surgery in the elderly: results from the Dutch National Registry

BACKGROUND: The increased human life expectancy and prevalence of obesity lead to more elderly people with obesity. As the popularity of bariatric surgery continues to grow, more elderly persons apply for bariatric surgery. However, because of the potentially higher surgical risk in elderly patients, bariatric surgery has been performed in small numbers. Moreover, the literature so far has shown controversial results. OBJECTIVE: To determine the safety of bariatric surgery in elderly patients in terms of 2-year morbidity and mortality. SETTING: Dutch nationwide mandatory registry for bariatric surgery. METHODS: A population-based retrospective cohort study. Elderly patients (aged ≥65 years) who received primary bariatric surgery between January 2015 and January 2020 were compared with the general bariatric surgical population (aged 18-65 years). RESULTS: Of 49,553 patients, 838 elderly patients (1.7%) were included. An intraoperative complication was registered in 1.2% of the elderly patients and 1.1% of the nonelderly patients (P = .814). A severe short-term complication (≤30 days) was registered in 38 elderly patients (4.5%) and 1071 nonelderly patients (2.2%) (P 30 days to ≤2 years) was significantly higher in nonelderly patients (3.7% versus 1.6%; P = .008). CONCLUSIONS: Bariatric surgery in elderly patients is safe in terms of perioperative outcome, mortality, and midterm complication rate. However, elderly patients experienced twice as many severe short-term complications. Bariatric surgery in elderly patients should be recommended on a case-by-case basis

The Effect of a Multidisciplinary Lifestyle Intervention on Health Parameters in Children versus Adolescents with Severe Obesity

Lifestyle interventions are the common treatment for children and adolescents with severe obesity. The efficacy of these interventions across age groups remain unknown. Therefore, this study aimed to compare the effectiveness of a lifestyle intervention on health parameters between children and adolescents with severe obesity. A longitudinal design was carried out at the Centre for Overweight Adolescent and Children's Healthcare (COACH) between December 2010 and June 2020. Children (2-11 years old, n = 83) and adolescents (12-18 years old, n = 77) with severe obesity received a long-term, tailored, multidisciplinary lifestyle intervention. After 1 year, 24 children (28.9%) and 33 adolescents (42.9%) dropped out of the intervention. The primary outcome was the change in body mass index (BMI) z-score after one and two years of intervention. The decrease in BMI z-score over time was significantly higher in children compared to adolescents, the mean decrease was 0.15 (0.08-0.23) versus 0.03 (-0.05-0.11) after one year and 0.25 (0.15-0.35) versus 0.06 (-0.06-0.17) after two years of intervention; p values for the difference between children and adolescents were 0.035 and 0.012. After two years, multiple improvements in cardio metabolic health parameters were observed, especially in children. In conclusion, during our tailored lifestyle intervention, a positive and maintained effect on health parameters was observed in children with severe obesity. Compared to children, the effect on health parameters was less pronounced in adolescents

Basal and Postprandial Myofibrillar Protein Synthesis Rates Do Not Differ between Lean and Obese Middle-Aged Men

Background: Excess lipid availability has been associated with the development of anabolic resistance. As such, obesity may be accompanied by impairments in muscle protein metabolism. Objective:We hypothesized that basal and postprandial muscle protein synthesis rates are lower in obese than in lean men. Methods: Twelve obese men [mean ± SEM age: 48 ± 2 y; BMI (in kg/m2): 37.0 ± 1.5; body fat: 32 ± 2%] and 12 age-matched lean controls (age: 43 ± 3 y; BMI: 23.4 ± 0.4; body fat: 21 ± 1%) received primed continuous L-[ring- 2H5]-phenylalanine and L-[ring-3,5-2H2]-tyrosine infusions and ingested 25 g intrinsically L-[1-13C]-phenylalanine labeled whey protein. Repeated blood andmuscle samples were obtained to assess protein digestion and amino acid absorption kinetics, and basal and postprandial myofibrillar protein synthesis rates. Results: Exogenous phenylalanine appearance rates increased after protein ingestion in both groups (P < 0.001), with a total of 53 ± 1% and 53 ± 2% of dietary protein–derived phenylalanine appearing in the circulation over the 5-h postprandial period in lean and obesemen, respectively (P = 0.82). After protein ingestion, whole-body protein synthesis and oxidation rates increased to a greater extent in lean men than in the obese (P-interaction < 0.05), resulting in a higher whole-body protein net balance in the lean than in the obese (7.1 ± 0.2 and 4.6 ± 0.4 μmol phenylalanine · h−1 · kg−1, respectively; P-interaction < 0.001). Myofibrillar protein synthesis rates increased from 0.030 ± 0.002 and 0.028 ± 0.003%/h in the postabsorptive period to 0.034 ± 0.002 and 0.035 ± 0.003%.h−1 in the 5-h postprandial period (P = 0.03) in lean and obese men, respectively, with no differences between groups (P-interaction = 0.58). Conclusions: Basal, postabsorptive myofibrillar protein synthesis rates do not differ between lean and obese middleaged men. Postprandial protein handling, including protein digestion and amino acid absorption, and the postprandial muscle protein synthetic response after the ingestion of 25 g whey protein are not impaired in obese men