Safety of Preoperative Vlcd Diet and Body Composition Changes After Bariatric Surgery

Takeshi Naitoh, MD, PhD, FACS, N Tanaka, MD, PhD, H Imoto, MD, PhD, M Nagao, MD, PhD, K Watanabe, MD, PhD, T Abe, MD, PhD, S Ohnuma, MD, PhD, K Kudo, MD, PhD, T Aoki, MD, PhD, H Karasawa, MD, PhD, T Tsuchiya, MD, F Motoi, MD, PhD, M Unno, MD, PhD. Tohoku University Graduate School of Medicine

Backgrounds: Bariatric surgery is known to improve obesity-related comorbidities and reduce the mortality risk. Patients willing to have this surgery are morbidly obese with their BMI is over 35, and most of patients have severe metabolic disorders such as diabetes mellitus or hyperlipidemia. Therefore, preoperative diet therapy with very low calorie diet (VLCD) is considered as useful to reduce operative morbidities. However, excessive diet therapy may lead to unexpected muscle protein decomposition, and might increase the risk of complications.

Aim: We measured the body composition changes pre and postoperative periods using the impedance body composition analyzer, and assess the safety of the preoperative VLCD diet.

Patients & Methods: Patients who underwent the bariatric surgery in our institute during 2010 and 2014 are included in this study. The body composition was measured with the impedance body composition analyzer at the time of first visit, before surgery, 1, 3, 6 and 12 months after surgery. Patients whose BMI is over 60 are asked to have complete VLCD diet in which intake calorie is approximately 500 kcal/day until their BMI came down to less than 60. All eligible patients are asked to have combination VLCD diet in which intake calorie is 1200 kcal/day for 4 weeks before surgery. Surgical procedures were Laparoscopic sleeve gastrectomy (LSG) or Laparoscopic sleeve gastrectomy with duodenal jejunal bypass (LSG/DJB). Perioperative complications were investigated and recorded as well.

Results: Twenty-one patients (M:F=10:11) were operated in our hospital: 15 cases of LSG, 6 of LSG/DJB, respectively. Average BMI is 48.5 at first visit and reduced to 44.2 at the time of before surgery. The body weight was reduced 11.6kg until surgery: fat tissue reduction is 3.2 kg, and skeletal muscle reduction is 0.8kg. There was no over grade-III morbidity and mortality. The body weight loss at 12 months after surgery is 28.7 kg in average. The fat tissue reduction was 23.3 kg, and the skeletal muscle reduction was 3.4 kg. Thus, the skeletal muscle reduction was minimum. Besides, the body fat percentage of LSG/DJB at 12 months after surgery is significantly less than the LSG group.

Conclusion: Since preoperative VLCD diet reduces mostly fat volume, but not the skeletal muscle volume, the VLCD diet therapy is safe and acceptable as a preoperative management. The body weight loss after surgery is also due to the fat tissue reduction, and it was enhanced in LSG/DJB patients.

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