title: Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: A randomized clinical trial A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity Weight Loss and Dietary Intake After Vertical Banded Gastroplasty and Roux‐en‐Y Gastric Bypass Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Effects of bariatric surgery on mortality in Swedish obese subjects. 11-Year Experience with Laparoscopic Adjustable Gastric Banding for Morbid Obesity—What Happened to the First 123 Patients? Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Nutritional Consequences of Adjustable Gastric Banding and Gastric Bypass: A 1-year Prospective Study A 10-year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates Body Composition, Dietary Intake, and Energy Expenditure After Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Vertical Banded Gastroplasty: A Randomized Clinical Trial Lean mass loss is associated with low protein intake during dietary-induced weight loss in postmenopausal women.
abstract: Background To evaluate the metabolic effects of two weight loss diets differing in macronutrient composition on features of dyslipidemia and post-pr and ial insulin ( INS ) response to a meal challenge in overweight/obese individuals . Methods This study was a parallel-arm r and omized 4 mo weight loss trial . Adults ( n = 50 , 47 ± 7 y ) matched on BMI ( 33.6 ± 0.6 kg/m2 , P = 0.79 )  consumed energy restricted diets ( deficit ~500 kcal/d ) : PRO ( 1.6 g.kg-1.d-1 protein and < 170 g/d carbohydrate ) or CHO ( 0.8 g.kg-1.d-1 protein and > 220 g/d carbohydrate ) for 4 mos . Meal challenges of respective diets were utilized for determination of blood lipids and post-pr and ial INS and glucose response at the beginning and end of the study . Results There was a trend for PRO to lose more weight ( -9.1 % vs. -7.3 % , P = 0.07 ) with a significant reduction in percent fat mass compared to CHO ( -8.7 % vs. -5.7 % ; P = 0.03 ) . PRO also favored reductions in triacylglycerol ( -34 % vs. -14 % ; P < 0.05 ) and increases in HDL-C ( + 5 % vs. -3 % ; P = 0.05 ) ; however , CHO favored reduction in LDL-C ( -7 % vs. + 2.5 % ; P < 0.05 ) . INS responses to the meal challenge were improved in PRO compared to CHO ( P < 0.05 ) at both 1 hr ( -34.3 % vs. -1.0 % ) and 2 hr ( -9.2 % vs. + 46.2 % ) , an effect that remained significant after controlling for weight or fat loss ( both P < 0.05 ) . Conclusion A weight loss diet with moderate carbohydrate , moderate protein results in more favorable changes in body composition , dyslipidemia , and post-pr and ial INS response compared to a high carbohydrate , low protein diet suggesting an additional benefit beyond weight management to include augmented risk reduction for metabolic disease Cl aims about the merits or risks of carbohydrate ( CHO ) vs. protein for weight loss diets are extensive , yet the ideal ratio of dietary carbohydrate to protein for adult health and weight management remains unknown . This study examined the efficacy of two weight loss diets with modified CHO/protein ratios to change body composition and blood lipids in adult women . Women ( n = 24 ; 45 to 56 y old ) with body mass indices > 26 kg/m(2 ) were assigned to either a CHO Group consuming a diet with a CHO/protein ratio of 3.5 ( 68 g protein/d ) or a Protein Group with a ratio of 1.4 ( 125 g protein/d ) . Diets were isoenergetic , providing 7100 kJ/d , and similar amounts of fat ( approximately 50 g/d ) . After consuming the diets for 10 wk , the CHO Group lost 6.96 + /- 1.36 kg body weight and the Protein Group lost 7.53 + /- 1.44 kg . Weight loss in the Protein Group was partitioned to a significantly higher loss of fat/lean ( 6.3 + /- 1.2 g/g ) compared with the CHO Group ( 3.8 + /- 0.9 ) . Both groups had significant reductions in serum cholesterol ( approximately 10 % ) , whereas the Protein Group also had significant reductions in triacylglycerols ( TAG ) ( 21 % ) and the ratio of TAG/HDL cholesterol ( 23 % ) . Women in the CHO Group had higher insulin responses to meals and postpr and ial hypoglycemia , whereas women in the Protein Group reported greater satiety . This study demonstrates that increasing the proportion of protein to carbohydrate in the diet of adult women has positive effects on body composition , blood lipids , glucose homeostasis and satiety during weight loss OBJECTIVE : To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets . DESIGN : R and omized dietary intervention study over six months comparing two ad libitum fat reduced diets ( 30 % of total energy ) strictly controlled in composition : High-carbohydrate ( HC , protein 12 % of total energy ) or high-protein ( HP , protein 25 % of total energy ) . SETTING AND PARTICIPANTS : Subjects were 65 healthy , overweight and obese subjects ( 50 women , 15 men , aged 18–55 y ) r and omly assigned to HC ( n=25 ) , HP ( n=25 ) or a control group ( C , n=15 ) . All food was provided by self- selection in a shop at the department , and compliance to the diet composition was evaluated by urinary nitrogen excretion . MAIN OUTCOME MEASURE : Change in body weight , body composition and blood lipids . RESULTS : More than 90 % completed the trial . Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group ( difference 3.7 kg , 95 % confidence interval (CI)(1.3–6.2 kg ) P<0.001 ) , and fat loss was 4.3 kg and 7.6 kg , respectively ( difference 3.3 kg ( 1.1–5.5 kg ) P<0.0001 ) , whereas no changes occurred in the control group . More subjects lost > 10 kg in the HP group ( 35 % ) than in the HC group ( 9 % ) . The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly . CONCLUSIONS : Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet , improves weight loss and increases the proportion of subjects achieving a clinical ly relevant weight loss . More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products , and hence improve adherence to low-fat diets in weight reduction programs Objective The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after  vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGB ) .  Background Summary Several independent r and omized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG . Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption , the relationships between calorie intake , food preferences , and postoperative weight loss are not well defined . Methods During the past 5 years , 138 patients were prospect ively selected for either VBG or RYGB , based on their preoperative eating habits . All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB .  Thirty patients were selected for VBG ; the remaining 108 patients were classified as “ sweets eaters ” or “ snackers ” and had RYGB . Detailed recall diet histories also were performed at each postoperative visit . Results Early morbidity rate was zero after VBG versus 3 % after RYGB . There were no deaths . Mean follow-up was 39 ± 11 months after VBG and 38 ± 14 months after RYGB . Mean weight loss peaked at 74 ± 23 lb at 12 months after VBG and 99 ± 24 lb at 16 months after RYGB ( p ≤ 0.001 ) . Twelve of 30 VBG patients lost > 50 % of their excess weight versus 100 of 108 RYGB patients ( p ≤ 0.0001 ) . Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months ( p ≤ 0.003 ) , whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively ( p ≤ 0.004 ) . Revision of VBG was performed in 6 of 30 patients ( 20 % ) for complications or poor weight loss , whereas only 2 of 108 patients who underwent RYGB required surgical revisions ( p ≤ 0.001 ) . Conclusions These data show that VBG adversely alters postoperative eating behavior toward soft , high-calorie foods , result ing in problematic postoperative weight loss . Conversely , RYGB patients had significantly greater weight loss despite inferior preoperative eating habits . The high rate BACKGROUND  Gastric restrictive surgery  induces a marked change in eating behavior . However , the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention . OBJECTIVE This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric b and ing ( LAGB )  and explored the nature and extent of change in eating patterns , their clinical associates , and impact on weight loss . METHODS AND PROCEDURES A 12-month observational study assessed presurgical and postsurgical binge eating disorder ( BED ) , uncontrolled eating , night eating syndrome ( NES ) , grazing , nutrient intake and eating-related behaviors , and markers of psychological distress .  A total of 129 subjects ( 26 male and 103 female , mean age 45.2 + /- 11.5 and BMI 44.3 + /- 6.8 ) participated in this study . RESULTS Presurgical BED , uncontrolled eating , and NES occurred in 14 % , 31 % , and 17.1 % of subjects , which reduced after surgery to 3.1 % , 22.5 % , and 7.8 % , respectively ( P = 0.05 for all ) . Grazing was prevalent before ( 26.3 % ) and after surgery ( 38.0 % ) . Preoperative BED most frequently became grazers ( P = 0.029 ) . The average percentage weight loss ( % WL ) was 20.8 + /- 8.5 % ; range -0.67 to 50.0 % and percentage of excess weight loss ( % EWL ) 50.0 + /- 20.7 % ; range -1.44 to 106.9 % ( P < 0.001 ) . Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer % WL ( P = 0.008 and P < 0.001 , respectively ) and elevated psychological distress . DISCUSSION Consistent with recent studies , uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery . Clearer characterization of favorable and unfavorable postsurgical eating behaviors , reliable methods to assess their presence , and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Background Few long-term studies regarding the outcome of  laparoscopic adjustable gastric b and ing for morbid obesity have so far been published . We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years ( mean 86 months ) of follow-up . Methods Data have been collected prospect ively among 280 patients operated since March 1996 . Until March 2002 ( minimum 5-year follow-up ) , 123 patients have been operated laparoscopically with the Swedish b and .  We report major late complications , reoperations , excess weight losses ( EWL ) and failure rates among these patients , with a mean ( range ) follow-up time of 86 months ( 60–132 ) . EWL < 25 % or major reoperation was considered as a failure . EWL > 50 % was considered a success . Results Mean ( range ) age of the patients ( male/female ratio 31:92 ) was 43 years ( 21–44 ) . Mean ( range ) preoperative weight was 130 kg ( 92–191 ) . Mean ( range ) preoperative body mass index was 49.28 kg/m2 ( 35.01–66.60 ) . Patients lost to follow-up was nearly 20 % at 5 years and 30 % at 8 years . Major late complications ( including b and erosions 3.3 % , slippage 6.5 % , leakage 9.8 % ) leading to major reoperation occurred in 30 patients ( 24.4 % ) . Nearly 40 % of the reoperations was performed during the third year after the operation . The mean EWL at 7 years was 56 % in patients with the b and in place , but 46 % in all patients . The failure rates increased from about 15 % during years 1 to 3 to nearly 40 % during years 8 and 9 . The success rate declined from nearly 60 % at 3 years to 35 % at 8 and 9 years . Conclusions Complications requiring reoperations are common during the third year after the operation , and almost 25 % of the patients will need at least one reoperation . Mean EWL in all patients does not exceed 50 % in 7 years or 40 % in 9 years and failure rates increase with time , up to 40 % at 9 years BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline Background Gastric bypass ( GBP ) is more efficient than adjustable gastric b and ing ( AGB ) on weight loss and comorbidities , but potentially induces more nutritional deficits . However , no study has compared the prevalence of nutritional deficiencies after these two bariatric procedures .We prospect ively comparedTo prospect ively compare the prevalence of nutritional deficiencies after AGB and GBP . Methods We have performed a 1-year prospect i ve study of nutritional parameters in 70 consecutive severe obese patients , who had undergone bariatric surgery , 21 AGB and 49 GBP .  After GBP , multivitamin supplements were systematic ally prescribed and vitamin B12 supplementation was introduced if a deficiency was observed . Results Patients lost more weight after GBP than after AGB ( 40 ± 13 vs 16 ± 8 kg , p < 0.001 ) . Vitamins B1 and C and iron deficiencies were frequent before surgery but were not worsened by GBP . AGB only induced a slight decrease of vitamin B1 at 1 year , whereas GBP induced significant decreases of vitamins B12 and E , serum prealbumin , and creatinine concentrations , with only minor clinical consequences . Anemia was observed in 10 % of the patients after bariatric surgery . Hemoglobin concentration was not correlated to vitamin B12 or folate concentrations but was related to iron status . Risk of iron deficiency anemia was better assessed by transferrin saturation than by serum ferritin concentration in this obese population . ConclusionS evere nutritional deficits can be avoided after bariatric surgery if patients are systematic ally supplemented with multivitamin and carefully monitored . However , specific care is required to avoid iron and vitamin B12 deficiencies , anemia , and protein malnutrition Background : Since its introduction about 10 years ago , and because of its encouraging early results regarding weight loss and morbidity ,  laparoscopic gastric b and ing ( LGB ) has been considered by many as the treatment of choice for morbid obesity . Few long-term studies have been published . We present our results after up to 8 years ( mean 74 months ) of follow-up . Methods : Prospect i ve data of patients who had LGB have been collected since 1995 , with exclusion of the first 30 patients ( learning curve ) . Major late complications are defined as those requiring b and removal ( major reoperation ) , with or without conversion to another procedure . Failure is defined as an excess weight loss ( EWL ) of < 25 % , or major reoperation . Results : Between June 1997 and June 2003 , LGB was performed in 317 patients , 43 men and 274 women . Mean age was 38 years ( 19 - 69 ) , mean weight was 119 kg ( 79 - 179 ) , and mean BMI was 43.5 kg/m2 ( 34 - 78 ) . 97.8 % of the patients were available for follow-up after 3 years , 88.2 % after 5 years , and 81.5 % after 7 years . Overall , 105 ( 33.1 % ) of the patients developed late complications , including b and erosion in 9.5 % , pouch dilatation/slippage in 6.3 % , and catheter- or port-related problems in 7.6 % . Major reoperation was required in 21.7 % of the patients . The mean EWL at 5 years was 58.5 % in patients with the b and still in place . The failure rate increased from 13.2 % after 18 months to 23.8 % at 3 , 31.5 % at 5 , and 36.9 % at 7 years . Conclusions : LGB appeared promising during the first few years after its introduction , but results worsen over time , despite improvements in the operative technique and material . Only about 60 % of the patients without major complication maintain an acceptable EWL in the long term . Each year adds 3 - 4 % to the major complication rate , which contributes to the total failure rate . With a nearly 40 % 5-year failure rate , and a 43 % 7-year success rate ( EWL > 50 % ) , LGB should no longer be considered as the procedure of choice for obesity . Until reliable selection criteria for patients at low risk for long-term complications are developed , other longer lasting procedures should be used Objective : To assess body composition , eating pattern , and basal metabolic rate in patients undergoing obesity surgery in a r and omized trial . Introduction : There is limited knowledge regarding how different bariatric surgical techniques function in terms of altering body composition , dietary intake , and basic metabolic rate . Methods : Non-superobese patients were r and omized to laparoscopic Roux-en-Y gastric bypass ( LGBP , n = 37 ) or laparoscopic vertical b and ed gastroplasty ( LVBG , n = 46 ) . Anthropometry , dual-energy x-ray absorptiometry ( DEXA ) , computed tomography ( CT ) , indirect calorimetry , and reported dietary intake were registered prior to and 1 year after surgery . Results : Follow-up rate was 97.6 % . LGBP patients had significantly greater reduction of waist circumference and sagittal diameter compared with LVBG . DEXA demonstrated a larger reduction of body fat in all compartments after LGBP , especially at the trunk ( P<0.001 ) . CT demonstrated more reduction of the visceral fat ( P=0.016 ) . Patients were able to eat all types of food after LGBP , although about 30 % cl aim ed they avoided fats . LGBP patients decreased their proportion of dietary fat significantly more than those operated on with LVBG ( P = 0.005 ) , who consumed more sweet foods and avoided whole meat and vegetables . Lean tissue mass ( LTM ) was proportionally less reduced , especially in men , after LGBP . The decreases in BMR postoperatively reflected the lower body mass in a pattern that did not differ among the groups . Conclusion : LGBP patients demonstrated better outcomes compared with LVBG patients in terms of body composition . Energy expenditure developed as expected postoperatively . A “ steering ” away from fatty foods after LGBP may be an important mechanism of action in gastric bypass The health and quality -of-life implication s of overweight and obesity span all ages in the United States . We investigated the association between dietary protein intake and loss of lean mass during weight loss in postmenopausal women through a retrospective analysis of a 20-week r and omized ,  controlled diet and exercise intervention in women aged 50 to 70 years . Weight loss was achieved by differing levels of caloric restriction and exercise . The diet-only group reduced caloric intake by 2,800 kcal/week , and the exercise groups reduced caloric intake by 2,400 kcal/week and expended approximately 400 kcal/week through aerobic exercise .  Total and appendicular lean mass was measured using dual energy x-ray absorptiometry . Linear regression analysis was used to examine the association between changes in lean mass and appendicular lean mass and dietary protein intake . Average weight loss was 10.8+/-4.0 kg , with an average of 32 % of total weight lost as lean mass . Protein intake averaged 0.62 g/kg body weight/day ( range=0.47 to 0.8 g/kg body weight/day ) . Participants who consumed higher amounts of dietary protein lost less lean mass and appendicular lean mass ( r=0.3 , P=0.01 and r=0.41 , P<0.001 , respectively ) . These associations remained significant after adjusting for intervention group and body size . Therefore , inadequate protein intake during caloric restriction may be associated with adverse body-composition changes in postmenopausal women
target: Although the strength of the evidence base is limited by the small number of studies , observational study design s and method ological weaknesses , the results indicate that short-term positive changes occur post surgery , including reduced caloric intake , contributed to by reductions in fat , carbohydrate and protein intake .
  There is a paucity of high- quality evidence regarding changes in dietary intake after LAGB .
background: BACKGROUND Laparoscopic adjustable gastric b and ing ( LAGB ) is currently one of the most popular surgical obesity treatments worldwide .
  Although dietary modification is recognised as a key factor in determining weight loss and health outcomes post surgery , existing evidence regarding changes in dietary intake after LAGB has not been systematic ally evaluated .
  This is essential for developing best- practice dietetic guidelines for the management of LAGB patients .
  The aim of this systematic review was to evaluate the current evidence base regarding changes in dietary intake after LAGB .