Nutritional intake and quality of life after laparoscopic sleeve gastrectomy

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Bowser, Jennifer
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Mount Saint Vincent University
Obesity has become an increasing health issue over the past several years. Weight loss surgery such as the Laparoscopic Sleeve Gastrectomy (LSG) is the only effective long term treatment option for morbid obesity. The nutritional intake and quality of life after LSG is not well known as it is a relatively new weight loss surgical procedure. Nutritional intake and quality of life after LSG was investigated to determine the nutritional intake and adequacy of diet in patients >1 year after LSG and the effect quality of life has on nutritional intake and percentage weight loss. Nutritional status was measured through the use of four day food records, nutritional related laboratory parameters, and reported nutritional vitamin supplement intake. Diet quality was measured using the Healthy Eating Index (HEI). Quality of life was measured using Bariatric Quality of Life (BQL) questionnaire. Participants were recruited through the Queen Elizabeth II Health Sciences Centre, Weight Loss Surgery Program, Halifax, Nova Scotia. Seventy-two patients who had the LSG between September 2008 and March 2010 and were able to read and write English were forwarded packages containing four day food record and Bariatric Quality of Life (BQL) Questionnaire. Food intake was analyzed using a nutrient analysis program. Food record data were used to calculate HEI scores and individual risk of micronutrient adequacy. Cronbach’s alpha was used to measure internal consistency of the BQL questionnaire.Variables pertaining to socio-demographics, laboratory parameters, quality of life, diet quality, and dietary intake were included in the statistical analysis. Pearson Correlation analysis was used to measure associations between continuous variables and twotailed t-tests were used to measure relationships between age group and continuous variables. Variables were dichotomized and Chi square test for independence was used to analyze categorical variables. Statistical significance was defined as p<.05. Nineteen adults completed the four day food records and BQL questionnaires giving a response rate of 26%. Average percentage weight loss was 26.1+/-10.6% 13 months after LSG. Average energy and protein intakes were 1256 +/- 384.5 kilocalories and 77.3+/-17.5 g per day respectively 22 months after surgery. Participants <50 years of age lost more weight, had higher BQL scores, and consumed less energy than those >50. Mean BQL and HEI scores were 78.1+/-14.0 and 60.4+/-8.8 respectively 22 months after surgery. All participants were at risk for at least one inadequate dietary micronutrient intake. The prevalence of nutrient deficiency was 10.5% with vitamin B12 being the only micronutrient deficiency. Ninety-five percent of participants reported taking a multi-vitamin/mineral supplement. Nutritional intake after LSG does not appear adequate to meet needs and multivitamin/ mineral supplementation seems effective at preventing nutritional deficiencies. Risk of inadequate dietary micronutrient intake appears to be related to the number of food guide servings consumed. Quality of life is acceptable and is dependent on weight loss. There is no relationship between nutritional intake and quality of life. Diet quality scores are considered “needs improvement” which is comparable to the rest of the Canadian population. A combination of tools should be used when assessing the nutritional status of a population and more research is needed on the long term nutritional status after LSG. It is recommended to use tools that are specific to the bariatric surgery population when measuring quality of life.