A Conservative Weight Loss Intervention Relieves Bowel Symptoms in Morbidly Obese Subjects with Irritable Bowel Syndrome: A Prospective Cohort Study

2018

BMC Obes

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BackgroundGastrointestinal (GI) co-morbidity is common in obese patients, but the effect of weight loss surgery on GI symptoms is incompletely elucidated. The aims of the present study were to explore changes in GI symptoms and food tolerance following weight loss surgery and to study whether such changes were associated with dietary modifications and/or the type of surgical procedure [Roux-en-Y Gastric Bypass (RYGB) versus Vertical Sleeve Gastrectomy (VSG)].MethodsParticipants: Patients with morbid obesity scheduled for weight loss surgery.The patients filled in paper-based questionnaires addressing diet, GI symptoms (bloating, pain, satiety, constipation and diarrhea) and food tolerance/quality of alimentation (satisfaction about current food intake, tolerance to specific foods and frequency of vomiting/regurgitation/reflux) 6 months prior to and 6 months after the surgery. Patients with pre-existing major GI co-morbidity or previous major GI surgery were excluded.ResultsFifty-four patients (RYGB/VSG: 43/11) were included. Constipation and satiety increased and food tolerance decreased significantly after the surgery (all p-values < 0.05). The increase in satiety was significantly more notable after VSG than after RYGB (p < 0.05).The increase in satiety also correlated with an overall reduction in food tolerance (rho: -0.488, p < 0.01). Divergent changes were seen in the frequency of vomiting/regurgitation/reflux, with a decline after RYGB (p = 0.01) and an increase after VSG (p = 0.06). Intakes of energy, macronutrients, fiber and fluid decreased significantly after the surgery (all p-values < 0.05), but did not correlate with the changes in constipation, satiety or food tolerance (all p-values > 0.05). Pre-operatively, total energy intake correlated with bloating and abdominal pain (rho = 0.343 and 0.310 respectively, p < 0.05 for both), but these correlations did not persist 6 months after the surgery (rho = 0.065 and 0.054 respectively, p > 0.05 for both).ConclusionA high caloric intake may explain some of the GI symptoms experienced by non-operated obese patients. The worsening or new-onset of symptoms post-surgery is likely due to anatomical or physiological alterations following surgery. The increase in satiety and the decrease in food tolerance are likely explained by the restrictive nature of the surgeries, as satiety increased more after VSG than after RYGB and correlated with an overall reduction in food tolerance.

Section: Discussionmentioning

confidence: 99%

“…The patients received dietary and lifestyle counseling at enrolment as well as at the follow-up visits. The pre-surgery intervention has been described in more detail previously [ 17 ]. The patients also received oral and written information regarding the dietary principles to be followed after the surgery (e.g.…”

Section: Methodsmentioning

confidence: 99%

Changes in gastrointestinal symptoms and food tolerance 6 months following weight loss surgery: associations with dietary changes, weight loss and the surgical procedure

Kvehaugen

2018

BMC Obes

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“…Some weeks later, they participated in weekly group meetings for seven weeks chaired by nurses, nutritionists, surgeons and a psychologist. The last three weeks before surgery, they followed a strict "crispbread diet" containing 4200 kJ of energy [15].…”

Section: Interventionsmentioning

confidence: 99%

Changes in Faecal Short-Chain Fatty Acids after Weight-Loss Interventions in Subjects with Morbid Obesity

Valeur

2020

Nutrients

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The gut microbiota and their metabolites, e.g., short-chain fatty acids (SCFA), are associated with obesity. The primary aims were to study faecal SCFA levels and the changes in SCFA levels after weight-loss interventions in subjects with obesity, and secondarily, to study factors associated with the faecal SCFA levels. In total, 90 subjects (men / women: 15/75) with a mean age of 44.4 (SD 8.4) years, BMI 41.7 (SD 3.7) kg/m 2 and morbid obesity (BMI > 40 or > 35 kg/m 2 with obesity-related complications) were included. Faecal SCFA and other variables were measured at inclusion and after a six-month conservative weight-loss intervention followed by bariatric surgery (Roux-en-Y gastric bypass or gastric sleeve). Six months after surgery, the total amount of SCFA was reduced, the total and relative amounts of the main straight SCFA (acetic-, propionic-, and butyric-acids) were reduced, and the total and relative amounts of branched SCFA (isobutyric-, isovaleric-, and isocaproicacids) were increased. The changes indicate a shift toward a proteolytic fermentation pattern with unfavorable health effects. The amount of SCFA was associated with the diet but not with metabolic markers or makers of the faecal microbiota composition. Dietary interventions could counteract the unfavorable effects.Nutrients 2020, 12, 802 2 of 12 between SCFA and the diet, the faecal microbiome composition and some metabolic and inflammatory biomarkers (HbA1c, CRP, and s-zonulin). Materials and Methods Study DesignConsecutive subjects with morbid obesity referred to Innlandet Hospital Trust, Gjøvik, Norway for evaluation of bariatric surgery were evaluated for inclusion in this prospective cohort study. After inclusion (T 1) and before bariatric surgery, the subjects completed a six-month conservative treatment period. This is standard procedure, and the conservative weight loss intervention helps the subjects to adapt to lifestyle changes. There was a follow-up visit six months after surgery (T 2). Inclusion CriteriaSubjects 18-65 years of age with morbid obesity (defined as BMI > 40 kg/m 2 or > 35 kg/m 2 with obesity-related complications) were available for inclusion. Subjects with previous major gastrointestinal surgery, organic gastrointestinal disorders, alcohol and drug abuse, major psychiatric disorders, and serious somatic disorders not related to obesity were excluded.

“…The conservative weight loss intervention with group counselling and personalised lifestyle interventions was based on the weight loss programs used in most Norwegian obesity clinics in this period of time [16], with some small local changes from the national standard due to availability of personnel. The intervention was organised as a series of outpatient visits [16,17]. The intervention started with three outpatient consultations of one-hour duration with a nurse, a nutritionist and a physician.…”

Section: The Conservative Weight Loss Interventionmentioning

confidence: 99%

“…The dietary recommendations were based on a reduced daily energy intake and recommendation of food items with a high micronutrient content [17]. The participants were adviced to eat less sugar and fat and more fibre and protein.…”

Section: The Conservative Weight Loss Interventionmentioning

confidence: 99%

Changes in serum zonulin in individuals with morbid obesity after weight-loss interventions: a prospective cohort study

Aasbrenn

Lydersen²,

2020

BMC Endocr Disord

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Background: Zonulin is a biomarker of impaired intestinal permeability, which has been associated with various disorders. The primary aim was to study serum zonulin (s-zonulin) in individuals with morbid obesity before and after a conservative weight loss intervention followed by bariatric surgery. The secondary aims were to explore predictors of s-zonulin, and the associations between the changes of the predictors and changes in s-zonulin, and to compare the associations in the two treatment periods. Methods: Individuals with morbid obesity were included. Data before any weight loss interventions, after a 6 months' conservative weight loss intervention, and 6 months after bariatric surgery were used. S-zonulin was measured with an ELISA method from Immundiagnostik AB, Bensheim, Germany. Data were analysed with mixed models. Results: The mean body mass index was 42.1 kg/m 2 (SD 3.8) at inclusion and was reduced to 38.7 kg/m 2 (SD 3.8) and 29.8 kg/m 2 (SD 3.8) after the conservative treatment and bariatric surgery respectively. S-zonulin was 63 ng/mL (SD 32) at inclusion and was reduced with 19 ng/ml (95% CI 12 to 26, p < 0.001) after conservative treatment and 11 ng/ml (95% CI 0 to 21, p = 0.04) after bariatric surgery. At inclusion, s-zonulin was significantly associated with factors including p-glucose (B = 2.21, 95% CI 1.09 to 3.33, p < 0.001), c-reactive protein (B = 1.02, 95% CI 0.45 to 1.58, p < 0.001) and the intake of proteins (B = 0.23, 95% CI 0.08 to 0.38, p = 0.003) and non-nutritive sweeteners (B = 0.68, 95% CI 0.19 to 1.17, p = 0.007). The reduction in s-zonulin after the conservative weight loss intervention was significantly associated with improvement in diarrhoea (B = 6.6, 95% CI 1.3 to 11.8, p = 0.02), HbA1c (B = 9.7, 95% CI 1.1 to 18.3, p = 0.03), p-glucose (B = 3.5, 95% CI 1.2 to 5.9, p = 0.004) and gamma-GT (B = 0.28, 95% CI 0.09 to 0.47, p = 0.004), but not associated with the change in body mass index (B = 0.9, 95% CI − 1.5 to 3.3, p = 0.46). Conclusions: S-zonulin was markedly reduced after the conservative weight loss intervention, and further reduced after bariatric surgery. The reduction in s-zonulin was associated with improvement of diarrhoea, markers of glucose intolerance and liver disease, but not associated with the change in body mass index.