title: Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study. The Micronutrient Intake Profile of a Multicentre Cohort of Australian LAGB Patients The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study Do Bariatric Patients Follow Dietary and Lifestyle Recommendations during the First Postoperative Year? Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. Undereating and underrecording of habitual food intake in obese men: selective underreporting of fat intake. Micronutrient and Protein Deficiencies After Gastric Bypass and Sleeve Gastrectomy: a 1-year Follow-up Weight Loss and Dietary Intake After Vertical Banded Gastroplasty and Roux‐en‐Y Gastric Bypass A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery Gastric bypass surgery for obesity decreases the reward value of a sweet-fat stimulus as assessed in a progressive ratio task. Dietary intake of female bariatric patients after anti-obesity gastroplasty. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Food Intake and Changes in Eating Behavior After Laparoscopic Sleeve Gastrectomy Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients.
abstract: Background : Approximately 20 - 30 % of obese patients do not achieve successful weight outcomes after bariatric surgery . Objective : We examined whether short-term changes ( ≤0.5 y postsurgery ) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change . Design : Participants were recruited from the Swedish Obese Subjects ( SOS ) study , which was a matched ( nonr and omized ) prospect i ve trial that compared bariatric surgery with usual care for obese patients . A total of 2010 patients who underwent bariatric surgery were included in the study .  Physical examinations ( e.g. , weight ) and question naires ( e.g. , dietary question naire ) were completed before and 0.5 , 1 , 2 , 3 , 4 , 6 , 8 , and 10 y after surgery . For the main analytic strategy , a linear mixed model was implemented , which included repeated measures with a r and om intercept and an unstructured covariance matrix . Results : Short-term changes in energy intake ( P < 0.001 ) and in relative proportions of energy from carbohydrates ( P < 0.001 ) , fat ( P < 0.001 ) , and protein ( P < 0.05 ) were associated with 10-y weight change after bariatric surgery . At the 10-y follow-up , men and women with the largest reductions in energy intake had lost 7.3 % and 3.9 % more weight , respectively , compared with that of subjects with the smallest intake reductions ( P < 0.001 ) . Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition ( P < 0.05 ) . Conclusions : The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss . Weight loss is also associated with a changing dietary macronutrient composition . This trial was registered at clinical trials.gov as NCT01479452 Background Patients who have undergone bariatric surgery have increased risks of developing micronutrient deficiencies . Translational research investigating the actual micronutrient intake of bariatric patients is limited . We examined the  micronutrient intake  of a multicentre cohort of laparoscopic adjustable gastric b and ing patients 1 year post-surgery . These data were compared to micronutrient recommendations for the general population . Methods Consecutive patients from three bariatric surgery facilities in Melbourne , Australia , were invited to participate 12 months post-operatively . A vali date d food frequency question naire was posted to 215 prospect i ve participants . Results Of the 52 participants , micronutrient intakes from food and fluids alone were below population recommendations for calcium , folate , magnesium , potassium , retinol equivalents , thiamin and vitamin E. Males did not meet the recommended intakes for zinc , and iron intakes in pre-menopausal women were insufficient . Intakes lower than recommended levels for these micronutrients suggest inadequate intake of foods from vegetable , dairy , lean meat ( or alternatives ) and wholegrains . Micronutrient intakes below recommended levels in this patient group can be further explained by their macronutrient intakes that suggested diets of poor nutrient density . Recommendations for supplementation in this group have wide variations , usually having been developed through the presence of clinical and biochemical deficiencies . Conclusions Nutritional supplementation should be more extensive in scope and dosage than is currently recommended by some professional guidelines . Further long-term studies are needed to explore both macro- and micronutrient intakes on the morbidity and mortality of this patient population Background Data on gastrointestinal ( GI ) and dietary changes following bariatric surgery are scarce in the Middle Eastern region . The objective of this work was to retrospectively compare dietary intake , food preferences , and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) . Methods Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective , non-r and omized , and observational study . All subjects completed three question naires ( GI symptoms , food preferences , and quantitative food frequency question naire ( FFQ ) ) and three 24-h recalls . Results At one year postoperatively , both surgical groups showed similar percentage of excess weight loss that exceeded 50 % . In addition , percentage of carbohydrate , protein , and sugar intake from total energy , frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups . RYGB subjects consumed significantly more fruits and juices from total energy ( P < 0.05 ) whereas SG subjects tended to consume more sweets and desserts . Heartburn ( P < 0.001 ) , regurgitation ( P < 0.01 ) , nausea ( P < 0.01 ) , vomiting ( P < 0.001 ) , and constipation ( P < 0.05 ) were significantly more frequent among SG subjects . Flatulence ( P < 0.001 ) and diarrhea ( P < 0.05 ) , as well as dizziness ( P < 0.001 ) , and fast heartbeat ( P < 0.05 ) after eating were significantly more frequent after RYGB . Conclusions There were no major differences in dietary intake and food preferences between RYGB and SG groups . There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure , which might impact eating behavior Background Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce . Thus , the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy ( LSG ) surgery . Methods A prospect i ve cohort study with 12 months of follow-up on 100 LSG patients was conducted . Data were collected at baseline and at 3 ( M3 ) , 6 ( M6 ) , and 12 ( M12 ) months post-surgery and included anthropometrics , biochemical tests , food intake , food tolerance , common surgery-related side effects , physical activity ( PA ) , supplementation , and number of follow-up meetings with a dietitian .  Results Data were available for 77 patients ( 57.1 % women , mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m2 ) . Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points ( ≤40.3 % ) and ≥6 meetings with a dietitian at M12 ( 41.6 % ) . Half of the patients performed ≥150 min/week of PA at all time points ( ≤50.6 % ) as recommended . PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 ( P ≤ 0.044 ) . Most of the patients adhered to the recommended supplementation at all time points ( ≥57.1 % ) . Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid , iron , hemoglobin , and vitamins D and B12 ( P ≤ 0.056 for all ) . Adherence to all recommendations was not significantly associated with excess weight loss ≥60 % at M12 ( P ≥ 0.195 for all ) . Conclusion Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG ; however , adherence to those recommendations was not related to better weight loss at short-term follow-up . Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively OBJECTIVE The effects of food tolerance ( if any ) on diet quality several years post-surgery remain unclear . Our study aim ed to assess food tolerance and diet quality after three  bariatric  procedures ; adjustable gastric b and ing ( AGB ) , sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGBP ) , 2â??4 years post-surgery . METHODS This prospect i ve , cross-sectional study assessed weight loss , food tolerance and diet quality in 130 subjects ( 14 obese pre-surgical controls , 13 AGB , 62 SG and 41 RYGBP ) . Inclusion criteria selected patients who underwent bariatric surgery between 1 January 2007 and 31 December 2008 , at a single bariatric clinic . Non-parametric tests ( Kruksalâ??Wallis and Mannâ??Whitney ) along with Spearman 's correlation coefficient analysis were used . RESULTS Superior food tolerance was reported by the control ( 24.5 ) , SG ( 24.0 ) and RYGBP ( 22.0 ) groups , compared with the AGB group ( 15.5 ; P < 0.001 ) . The control and AGB groups consumed significantly more high-calorie extra foods ( 9.2 and 7.7 daily serves respectively ) compared with the SG ( 3.4 serves ) and RYGBP ( 4.0 serves ) groups . There were several significant correlations between food tolerance and dietary intake including breads and cereals and meat and meat alternatives . CONCLUSION The control and AGB groups consumed significantly more high-calorie extra foods , a result that was paralleled by poor weight loss and food tolerance outcomes for the AGB group . A significant positive relationship between food tolerance and diet quality was established . Poor food tolerance and thus compromised diet quality need to be considered as post-surgical complications of the AGB procedure BACKGROUND Underreporting of food intake is common in obese subjects . OBJECTIVE One aim of this study was to assess to what extent underreporting by obese men is explained by underrecording ( failure to record in a food diary everything that is consumed ) or undereating . Another aim of the study was to find out whether there was an indication for selective underreporting . DESIGN Subjects were 30 obese men with a mean ( + /-SD ) body mass index ( in kg/m(2 ) ) of 34 + /- 4 .  Total food intake was measured over 1 wk . Energy expenditure ( EE ) was measured with the doubly labeled water method , and water loss was estimated with deuterium-labeled water .  Energy balance was checked for by measuring body weight at the start and end of the food-recording week and 1 wk after the recording week . RESULTS Mean energy intake and EE were 10.4 + /- 2.5 and 16.7 + /- 2 . 4 MJ/d , respectively ; underreporting was 37 + /- 16 % . The mean body mass loss of 1.0 + /- 1.3 kg over the recording week was significantly different ( P < 0.05 ) from the change in body mass over the nonrecording week , and indicated 26 % undereating . Water intake ( reported + metabolic water ) and water loss were significantly different from each other and indicated 12 % underrecording . The reported percentage of energy from fat was a function of the level of underreporting : percentage of energy from fat = 46 - 0.2 x percentage of underreporting ( r(2 ) = 0.28 , P = 0.003 ) . CONCLUSIONS Total underreporting by the obese men was explained by underrecording and undereating . The obese men selectively underreported fat intake Background Roux-en-Y gastric bypass ( GBP ) and sleeve gastrectomy ( SG ) have increased dramatically , potentially increasing the prevalence of nutritional deficiencies . The aim of this study was to analyze the effects of food restriction during the first year after  bariatric surgery ( BS ) on nutritional parameters . Methods Twenty-two and 30 obese patients undergoing GBP and SG  were prospect ively followed at baseline and 3 , 6 , and 12 months after BS ( N = 14 and N = 19 at T12 ) . We evaluated food intake and nutrient adequacy ( T0 , T3 , T12 ) , as well as serum vitamin and mineral concentration ( T0 , T3 , T6 , T12 ) . Results At baseline , GBP and SG patients had similar clinical characteristics , food intake , nutrient adequacy , and serum concentration . The drastic energy and food reduction led to very low probabilities of adequacy for nutrients similar in both models ( T3 , T12 ) . Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up , indicating mild protein depletion in 37 and 38 % of GBP patients and 57 and 52 % of SG patients , respectively , at T3 and T12 . Conversely , despite the low probabilities of adequacy observed at T3 and T12 , systematic multivitamin and mineral supplementation after GBP and SG prevented most nutritional deficiencies . Conclusions GBP and SG have comparable effects in terms of energy and food restriction and subsequent risk of micronutrient and protein deficiencies in the first year post BS . Such results advocate for a cautious monitoring of protein intake after GPB and SG and a systematic multivitamin and mineral supplementation in the first year after SG 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 Bariatric surgery is often associated with reduced food tolerance and sometimes frequent vomiting , which influence quality of life , but are not included in the overall evaluation of these procedures , notably the BAROS . Our aim was to develop a simple question naire to evaluate food tolerance during follow-up visits . Methods A one-page question naire including questions about overall satisfaction regarding quality of alimentation , timing of eating over the day , tolerance to several types of food , and frequency of vomiting/ regurgitation was developed . A composite score was derived from this question naire , giving a score of 1 to 27.Validation was performed with a group of nonobese adults and a group of morbidly obese nonoperated patients . Patients were administered the question naire at follow-up visits since January 1999 . Data were collected prospect ively . Results It takes 1–2 minutes to fill out the question naire . Food tolerance is worse in the morbidly obese population compared with non-obese adults ( 24.2 vs 25.2 , P=0.004 ) . Following Roux-en-Y gastric bypass , food tolerance is reduced after 3 months ( 21.2 ) , but becomes comparable to that of the normal population and remains so at 1 year postoperatively . Following gastric b and ing , food tolerance is already significantly reduced after 3 months ( 22.3 ) , and worsens continuously over time ( 19.03 after 7 years ) . In the gastric b and ing population , the decision to adjust the b and is based at least partially on food tolerance , and the question naire proved helpful in that respect . Conclusion Our new question naire proved very easy to use , and helpful in day-to-day practice , especially after gastric b and ing . It was also helpful in comparing food tolerance over time after surgery , and in comparing food tolerance between procedures . Evaluation of food tolerance should be part of the overall evaluation of the results after bariatric surgery BACKGROUND Obesity is among the leading causes of disease and death . Bariatric surgery is the most effective treatment of obesity . There is increasing evidence that after gastric bypass surgery , patients and animal models show a decreased preference for sweet and fatty foods . The underlying mechanism may include alterations in taste function . OBJECTIVE We hypothesize that a gastric bypass reduces the reward value of sweet and fat tastes . DESIGN In this prospect i ve case-control study , 11 obese patients who were scheduled to undergo a gastric bypass and 11 normal-weight control subjects in the fed state  clicked a computer mouse to receive a sweet and fatty c and y on a progressive ratio schedule 10 wk apart ( in patients , testing took place 2 wk before and 8 wk after gastric bypass surgery ) . Subjects worked progressively harder to obtain a food reward ( reinforcer ) until they stopped clicking ( ie , the breakpoint ) , which was a measure of the reinforcer value . Breakpoints were assessed by the number of mouse clicks in the last completed ratio . The experiment was repeated in a different cohort by using vegetable pieces as the reinforcer . RESULTS Breakpoints in the test sessions of control subjects correlated highly for both reinforcers . The median breakpoint for c and ies , but not vegetables , was reduced by 50 % in the obese group after gastric bypass . Patients with the largest reduction in the breakpoint had the largest decrease in BMI . CONCLUSIONS Gastric bypass surgery result ed in the selective reduction of the reward value of a sweet and fat tastant . This application of the progressive ratio task provided an objective and reliable evaluation of taste-driven motivated behavior for food stimuli after obesity surgery PURPOSE Roux-en-Y gastric bypass is a popular and successful operation for the treatment of morbid obesity . However , it greatly restricts ingestion and moderately interferes with absorption of food , thus potentially paving the way for undernutrition , especially during the first year before patients adapt to the new condition . Aim ing to document actual dietary intake during this period , a prospect i ve observational study was performed . METHODS Forty consecutive patients were investigated using a 24-hour dietary recall technique  every 3 months after surgery for 1 year . Females only were accepted for greater homogeneity of the sample . All received a vitamin and mineral supplement on a daily basis as a postoperative routine . A question naire was employed regarding general , nutritional , and gastrointestinal changes as well as consumption of medications . Dietary intake was analyzed after data processing using the Virtual Nutri software package ( São Paulo , SP , Brazil ) . RESULTS The surgical response was within the expected range , with about 67 % excess weight loss at the end of the 1st year , and the same occurred with gastrointestinal symptoms and drug requirements . Daily energy intake on the 4 analyzed occasions was 529.4 + /- 47.4 , 710.9 + /- 47.6 , 833.2 + /- 72.0 , and 866.2 + /- 95,1 kcal/day ( mean + /- SEM ) ; protein intake was increased in the same proportion at 6 and 9 months , but reduced at 12 months . Thus , patients did not meet st and ard recommendations regarding calories and proteins , even at the end of the 1st year ; iron and zinc intake were also inadequate , although deficiencies were probably staved off by the prescribed supplement preparation . CONCLUSIONS 1 ) The risk for postoperative undernutrition was evidence d up to 1 year , while spontaneous improvement in food intake was slow and inefficient ; 2 ) Specific protocol s should be devised to improve nutrition and health during the postoperative phase until successful dietary adaptation is achieved BACKGROUND The effect of a Roux-en-Y gastric bypass ( RYGB ) on body weight has been amply documented , but few studies have simultaneously assessed the evolution of energy and macronutrient intakes , energy expenditure , and changes in body composition over time after an RYGB . OBJECTIVE We evaluated energy and macronutrient intakes , body composition , and the basal metabolic rate ( BMR ) in obese female patients during the initial 3 y after an RYGB . METHODS Sixteen women with a mean ± SEM body mass index ( in kg/m(2 ) ) of 44.1 ± 1.6 were included in this prospect i ve observational study . The women were studied on 6 different occasions as follows : before and 1 , 3 , 6 , 12 ( n = 16 ) , and 36 ( n = 8) mo after surgery . On each occasion , food intake was evaluated from 4- or 7-d dietary records , body composition was assessed with the use of bio-impedancemetry , and energy expenditure was measured with the use of indirect calorimetry . RESULTS Body weight evolution showed the typical pattern reported after an RYGB . Total energy intake was 2072 ± 108 kcal/d at baseline and decreased to 681 ± 58 kcal/d at 1 mo after surgery ( P < 0.05 compared with at baseline ) . Total energy intake progressively increased to reach 1240 ± 87 kcal/d at 12 mo after surgery ( P < 0.05 compared with at 1 mo after surgery ) and 1448 ± 57 kcal/d at 36 mo after surgery ( P < 0.05 compared with at 12 mo after surgery ) . Protein intake was 87 ± 4 g/d at baseline and ± 2 g/d 1 mo after surgery ( P < 0.05 compared with at baseline ) and increased progressively thereafter to reach 57 ± 3 g/d at 36 mo after surgery ( P < 0.05 compared with at 1 mo after surgery ) . Carbohydrate and fat intakes over time showed similar patterns . Protein intake from meat and cheese were significantly reduced early at 1 mo after surgery but increased thereafter ( P < 0.05 ) . The BMR decreased from 1.12 ± 0.04 kcal/min at baseline to 0.93 ± 0.03 , 0.86 ± 0.03 , and 0.85 ± 0.04 kcal/min at 3 , 12 , and 36 mo after surgery , respectively ( all P < 0.05 compared with at baseline ) . CONCLUSIONS Total energy , carbohydrate , fat , and protein intakes decreased markedly during the initial 1 - 3 mo after an RYGB , whereas the BMR moderately decreased . The reduction in protein intake was particularly severe at 1 mo after surgery , and protein intake increased gradually after 3 - 6 mo after surgery . This trial was registered at clinical trials.gov as NCT01891591 Background  Laparoscopic sleeve gastrectomy ( LSG )  results in reduced calorie intake and weight loss . Whether patients consume the same types of food before and after surgery or whether they reduce the volume and calorie density of the foods they consume remains unknown . Objectives The aim of this prospect i ve study was to evaluate the changes in daily caloric and macronutrient intake after LSG and the relation between changes of taste and food tolerance over 2 years . Methods Thirty morbidly obese patients with median body mass index ( BMI ) of 43.9 kg/m2 ( 39.5–57.3 ) were prospect ively enrolled prior to LSG .  Weight , BMI , % EWL , weight loss percentage ( % WL ) , and daily intake were evaluated preoperatively at 1 , 3 , 6 , 12 , and 24 months after surgery along with a question naire evaluating food choices , quality of eating , tolerance of certain types of food , frequency of vomiting , and changes in taste . Results The median % EWL and % WL at 12 and 24 months was 65 % ( 33.9–93.6 % ) , 27.3 % ( 14.2–45.5 % ) and 71.5 % ( 39.6–101.1 % ) , 31 % ( 19.1–50.3 % ) respectively . Six months after surgery , the daily caloric intake reduced by 68 % and the reduction was maintained until 24 months . The median score of the eating question naire was 18 ( 10–27 ) at 6 months , 22 ( 16–26 ) at 12 months , and 23 ( 10–27 ) at 24 months , suggesting that the quality of nutrition improved over time . At 6 , 12 , and 24 months , 75 % of the patients reported changes in taste with reduced interest in sweets , high fat food , and alcoholic drinks . However , at 24 months , 20 % of patients reported a heightened interest in sweets compared to 12 months previously . Conclusions LSG reduced calorie intake both through volume of food and the calorie density of the food consumed . The mechanisms for the changes in food preferences may involve both unconditioned and conditioned effects . The influence of dietary counseling on learning which foods are consumed still requires further exploration 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 Data on long-term dietary changes and nutritional deficiencies after  sleeve gastrectomy ( SG ) in grade 3 obese patients are scarce . OBJECTIVE To prospect ively compare dietary changes and nutritional deficiencies in grade 3 obese patients 5 years after SG and Roux-en-y gastric bypass ( GBP ) .  PARTICIPANTS / SETTING Three hundred and fifty-five patients who had SG ( n=61 ) or GBP ( n=294 ) ( May 2001-December 2006 ) at a Spanish university hospital . DESIGN Longitudinal , prospect i ve , observational study . PRIMARY OUTCOMES /STATISTICAL ANALYSES : Changes in energy , macronutrient , and micronutrient intake , and weight loss were analyzed using mixed models for repeated measurements . RESULTS At the 5-year follow-up visit , the percentage of excess weight loss ( P=0.420 ) and daily energy intake ( P=0.826 ) , as well as the proportion of energy from carbohydrates ( P=0.303 ) , protein ( P=0.600 ) , and fat ( P=0.541 ) did not differ between surgical groups . Energy intake ( P=0.004 ) , baseline weight ( P<0.001 ) , and time period ( P<0.001 ) , but not the proportion of different macronutrients or the type of surgery , independently predicted the percentage excess weight loss over time . After SG or GBP , the mean daily dietary intake of calcium , magnesium , phosphorus , and iron was less than the current recommendations . Despite universal supplementation , the prevalence of nutritional deficiencies was comparable after SG or GBP , with 25-hydroxyvitamin D being the most commonly observed deficiency ( SG , 93.3 % to 100 % ; GBP , 90.9 % to 85.7 % , P = not significant ) . In an adjusted multivariate regression model , energy intake and lipid intake independently predicted plasma 25(OH)-vitamin D levels . CONCLUSIONS Data show that SG and GBP are associated with similar long-term weight loss with no differences in terms of dietary intake . Furthermore , data demonstrate that both types of surgeries carry comparable nutritional consequences BACKGROUND & AIMS Roux-en-Y gastric bypass  ( RYGB ) is associated with an increased risk for micronutrient deficiencies . This study aim ed to assess total ( dietary and supplement ) intake and association with iron ( including hepcidin ) , vitamin B12 , vitamin C and zinc status markers before and after Roux-en-Y gastric bypass ( RYGB ) . METHODS This prospect i ve study included patients with a planned RYGB in University Hospitals Leuven , Belgium ; who were followed until 12 months post-RYGB . Patients completed an estimated dietary record of two non-consecutive days before and 1 , 3 , 6 and 12 months post-RYGB and supplement/drug use was registered . Associations between total micronutrient intake and status markers were analyzed . RESULTS Fifty-four patients ( 21 males ; mean age : 48.0 [ 95%CI 46.6 ; 49.3 ] years ; mean preoperative BMI : 40.4 [ 95%CI 39.4 ; 41.4 ] kg/m2 ) were included . One month post-RYGB , usual dietary intake of the studied micronutrients was significantly decreased compared to pre-RYGB , but gradually increased until 12 months post-RYGB , remaining below baseline values . By including micronutrient supplement intake , 12 months post-RYGB values were higher than baseline , except for zinc . Hemoglobin , ferritin , vitamin B12 and C-reactive protein serum concentrations were significantly decreased and transferrin saturation and mean corpuscular volume were significantly increased 12 months post-RYGB . Serum hepcidin concentration was significantly decreased 6 months post-RYGB . CONCLUSIONS Medical nutritional therapy is essential following RYGB as dietary intake of iron , vitamin B12 , vitamin C , copper and zinc was markedly decreased postoperatively and some patients still had an inadequate total intake one year post-RYGB
target: The majority of studies were observational in nature and showed a reduction in energy intake following surgery , as well as inadequate intakes of micronutrients and protein , and an excessive intake of fats .
  There was evidence of nutrient imbalances , suboptimal compliance with multivitamin and mineral supplementation , and limited follow-up of patients .
  The current evidence base suggests that despite being effective in reducing energy intake , bariatric surgery can result in unbalanced diets , inadequate micronutrient and protein intakes , and excessive intakes of fats .
  In combination with suboptimal adherence to multivitamin and mineral supplementation , this may contribute to nutritional deficiencies and weight regain .
background: Bariatric surgery is currently the most effective treatment for morbid obesity .
  These procedures change the gastrointestinal system with the aim of reducing dietary intake .
  Improving diet quality is essential in maintaining nutritional health and achieving long-term benefits from the surgery .
  The aim of this systematic review was to examine the relationship between bariatric surgery and diet quality at least 1 year after surgery .