Five-year changes in dietary intake and body composition in adolescents with severe obesity undergoing laparoscopic Roux-en-Y gastric bypass surgery

https://doi.org/10.1016/j.soard.2018.10.011Get rights and content

Highlights

  • Sustained decrease in energy intake over 5 years following LRYGB.

  • Lower energy intake and DED after surgery compared to controls.

  • Girls lost less fat mass in comparison to boys who preserved more muscle mass.

  • Sufficient protein intake was associated with better preservation of muscle mass.

Abstract

Background

Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB).

Objectives

To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB.

Setting

University hospitals, multicenter study, Sweden.

Methods

Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years.

Results

Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P = .03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P = .003).

Conclusions

In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass.

Section snippets

Overview of study design

Adolescent Morbid Obesity Surgery is a Swedish nationwide 10-year prospective intervention multicenter study examining the feasibility and safety of adolescent patients with severe obesity (body mass index [BMI] ≥40 kg/m2) undergoing LRYGB at Sahlgrenska University Hospital (Gothenburg), recruited between February 2006 and June 2009 from 3 academic childhood obesity centers in Sweden: Stockholm, Gothenburg, and Malmö [5], [6]. Inclusion criteria were BMI ≥40 or ≥35 with obesity-related

Anthropometry

Adolescents undergoing LRYGB were older and with higher weight and BMI than the controls at baseline (Table 1).

Anthropometric measurements were complete at all time points in the LRYGB adolescents and in the controls at 5 years (Table 2).

Adolescents undergoing LRYGB had a substantial mean weight loss from baseline through 5 years, as reported [5], [6], [15] (Table 2), with no differences in percentage total weight loss, BMI, percentage BMI loss, or excess BMI lost between sexes (P > .05).

Dietary intake

Discussion

Weight loss and reduced energy intake remained lower after 5 years, similar to observations in adults [22], [27]. In the present study, there were no changes in macronutrient distribution of protein, carbohydrates, and fat at 1 and 2 years after surgery, consistent with earlier findings in adolescents after LRYGB [12]. However, the present study demonstrated a long-term decrease in protein and carbohydrate intake. This could be a result of the inclusion of fiber and alcohol in the calculations

Conclusion

Five years after LRYGB in adolescents with severe obesity there was a 28% weight loss, while controls gained 13%. Decreased energy intake and DED rather than modifications of macronutrient intake are important factors in weight loss after surgery. Ensuring adequate protein intake seems to improve preservation of muscle mass in adolescents after LRYGB.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    The manuscript is part of the Swedish nationwide 10-year prospective multicenter study Adolescent Morbid Obesity Surgery (AMOS) study, conducted at 3 childhood obesity centers: Stockholm, Gothenburg, and Malmö. AMOS is funded by the Swedish Research Council (521-2012-319), Vinnova: Sweden Intervention Bureau Grant (2013-01339), Swedish Heart and Lung Foundation, Research Council of Västra Götalands Regionen (VGFOUREG-307531), and the Swedish Freemason Child foundation, Gothenburg.

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