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Nutritional education

Patients require continuous nutritional education

Patients require continuous nutritional education work especially in groups of more than 18 months post-operatively

Patients require continuous nutritional education work especially in groups of more than 18 months post-operatively, according to a study published in the journal Nutricion Hospitalari.

The researchers from the Hospital Universitario Oswaldo Cruz (HUOC), in northeast Brazil, sought to evaluate the actual results of the surgery by taking into account the quality of life that includes parameters such as physical, mental and social well-being, plus the ability to eat and enjoy different kinds of food.

Study

They conducted a cross-sectional analytical of adults of both sexes, who underwent gastric bypass Roux-Y study from September to November 2010. The sample consisted of patients who were evaluated and followed by the multidisciplinary team at the Clinic’s Bariatric Surgery Program of the Oswaldo Cruz University Hospital/University of Pernambuco (HUOC/UPE).

Interviews were applied to the patients, in an individual questionnaire, with socio-demographic characteristics and information about the feeding habits as the number of daily meals, fluid intake and ability to consume or tolerate specific food such as meat, chicken, corn meal, rice , raw salad, sweets and others. This tolerance was assessed by the classification of food such as “easily eaten”, “hardly eaten” and “not eaten”.

The quality of life was assessed by applying a specific questionnaire, the method BAROS (Bariatric Analysis and Reporting Outcome System),15 which includes questions about self-esteem, physical status, social interaction, ability to work and/or study, sexual performance, percentage of loss of excess weight and dissatisfaction with side effects and complications of surgery.

The anthropometric assessment in the postoperative period was held during the consultation and nutritional anthropometric data of the preoperative period were recovered from patient charts. These were weighed in the standing position, wearing light clothes and barefoot, a digital scale platform type of Filizola, with a maximum capacity of 300kg and a variation of 100grams. The height was determined by anthropometric metal ruler two meters long, with fractions of 1cm, attached to the platform of digital scales.

Patients were kept standing, barefoot in the centre of the platform, feet together, upper limbs hanging over the body and in apnoea. The classification of nutritional status in the postoperative period was performed using BMI. The percentage of weight loss (% PP) and loss of excess weight (% PEP) were calculated according to the formulas proposed by Toneto.

Outcomes

Sixty six patients were interviewed within an average age of 42 ± 10.3 years, predominantly female, the majority with level of education of high school and 50% of the sample had family incomes between 1 to 3 minimum wages. There were no statistical differences regarding age and post-operative period.

The fact that a higher frequency of obesity was found in females can be justified by the demand for health services by women, and for this reason, the number of women treated when compared with the number of men seeking treatment is considerably larger. Although the PP% was higher in the postoperative period exceeding 18 months, no statistically significant difference was obtained.

There was no statistical difference between all variables between the two patient groups (6-18 and ≥ 18 months postoperatively). However, the majority reported an increase in chewing time in relation to preoperative (89.4%). The average time spent on each meal within 15 to 30 minutes was more frequent in both groups. As for fluid intake during meals, it was found that most do not consume them during meals, which according to the researchers, can be justified by the low tolerance for large volumes.

“Regarding to reduction of stomach capacity is important to emphasise the need to avoid the concomitant intake of liquids at meals, so that there is a further decrease in the amount of food consumed, and thus a depletion of nutritional status,” the researchers write.

An important point to note is the frequency of complications in the postoperative period, in which the most commonly complication cited by patients were dumping syndrome, affecting 39 (59%) patients. However, when evaluating the frequency of dumping syndrome according to the periods after surgery, there was no statistically significant difference (p=0.385). According to tolerance to specific foods, the most reported in the category “hardly eaten” were meat, chicken, rice, raw salad and corn meal. The food listed as “not eaten” were corn meal, followed by sweets, meat and chicken.

Regarding quality of life, it can be observed, which is classified as “good” for most patients in both groups of 6-18 months as an equal and greater than 18 months. However, patients with “bad” and “very good” ratings of quality of life were observed only in the group ≥18 months.

Conclusion

The researchers summarised that the evolution of weight loss and loss of excess weight was “satisfactory” in all postoperative periods evaluated.

They added that the results of the method BAROS in this study showed the effectiveness of surgery in this population, since the patients had “good” rating in most patients in both groups of 6-18 months as an equal and greater than 18 months.

“However, patients report quality of life in the classification “bad” only in the period ≥18 months, showing thus the importance of multidisciplinary monitoring, stimulating compliance dietary guidelines and the guidelines from other specialties, to achieve a satisfactory level of well-being and quality of life, both ultimate goals of the patient in question,” they concluded.

The complete article can be accessed here.

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