Laparoskopik Sleeve Gastrektomi Sonrası Morbid Obez Hastalarda Akdeniz Diyetinin Etkinliği

Year 2021, Volume: 5 Issue: 1, 33 - 37, 20.04.2021

Mehmet Nuri Koşar , Umut R. Gündüz , Onur İlkay Dinçer , Tuğrul Çakır

https://doi.org/10.46332/aemj.813541

Abstract

Amaç: Obezite, morbidite ve mortalite sorunlarının artmasına neden olan dünyadaki en önemli sağlık sorunlarından biridir. Cerrahi tedavi, son yıllarda ön plana çıkmakla birlikte Laparoskopik Sleeve Gastrektomi (LSG) sonrası tüm hastalara belli bir diyet reçete edilmekte ve eski beslenme alışkanlıklarının değiştirilmesi amaçlanmaktadır. Çalışmamızda LSG sonrası verilen iki farklı diyet reçetesinin etkinliği araştırılmıştır.

Araçlar ve Yöntem: Morbid obezite nedeni ile LSG yapılan hastalar (n=80), 1200 kalorilik Akdeniz proteininden zenginleştirilmiş ve standart protein kaynağı içeren diyet alanlar olmak üzere iki gruba ayrıldı. Her grupta 40 hasta prospektif gözlemsel olarak analiz edildi.

Bulgular: Çalışma grubu demografik verilerine gore değerlendirildiğinde hastaların 80%’inin kadınların oluşturduğu ve yaş ortalamasının 39.41±10.3 (min:19, max:61) yıl olduğu görüldü. Tüm hastalarda kilo, Vücut Kitle İndeksi (VKİ) ve ultrasonografik karaciğer yağlanma derecesi değerlerinde istatistiksel olarak anlamlı bir düşüş gözlendi (p<0.001). Hastaların diyet gruplarına göre kilo ve VKİ farkları karşılaştırıldığında, akdeniz diyeti uygulanan hastalarda kilo ve VKİ değerlerindeki azalmanın normal diyet uygulanan hastalara göre daha yüksek olduğu görülse de bu fark istatistiksel açıdan anlamlı bulunmadı (p=0.147, p=0.485,sırasıyla).

Sonuç: Çalışmamızda etkin yöntemin cerrahi olduğu, diyet tiplerinin kilo verimi ve non-alkolik yağlı karaciğer hastalığının düzelmesinde cerrahi kadar etkin olmadığı sonucuna varıldı.

Keywords

akdeniz diyeti, bariatrik cerrahi, non-alkolik yağlı karaciğer hastalığı, obezite

Supporting Institution

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Project Number

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Thanks

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The Effectiveness of Mediterranean Diet in Morbid Obese Patients After Laparoscopic Sleeve Gastrectomy

Abstract

Purpose: Obesity is one of the most important health problems in the world that causes increased morbidity and mortality problems.Although surgical treatment has come to the fore in recent years, a certain diet is prescribed to all patients after Laparoscopic Sleeve Gastrectomy (LSG) and it is aimed to change the old eating habits. In our study, the effectiveness of two different dietary prescriptions given after LSG was investigated.

Materials and Methods: Patients who underwent LSG due to morbid obesity (n=80) were divided into two groups as diet enriched with 1200-calorie Mediterranean protein and containing a standard protein source. 40 patients in each group were prospectively analysed observationally. 

Results: When the study group was evaluated according to demographic data, it was seen that 80% of the patients were women and the average age was 39.41±10.3 (min:19, max:61) years. A statistically significant decrease was observed in weight, body mass index (BMI) and ultrasonographic liver fatty levels in all patients (p<0.001). When the weight and BMI differences of the patients were compared according to the diet groups, it was observed that the decrease in weight and BMI values was higher in the patients who were applied the Mediterranean diet compared to the patients who received the normal diet, but this difference was not statistically significant (p =0.147, p =0.485 respectively).

Conclusion: In our study, it was concluded that the effective method is surgery, and diet types are not as effective as surgery in weight loss and recovery of non-alcoholic fatty liver disease.

Keywords

bariatric surgery, mediterranean diet, non-alcoholic fatty liver disease, obesity

Project Number

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References

• 1. Yıldız S, Çetinkaya F. Yetişkinlerde Obezite ve Yaşam Kalitesinin Değerlendirilmesi. Ahi Evran Med J. 2020; 4(2): 29-34.
• 2. Jakobsen GS, Småstuen MC, Sandbu R, et al. Association of Bariatric Surgery vs Medical Obesity Treatment With Longterm Medical Complications and Obesity-Related Comorbidities.JAMA. 2018;319(3):291–301.
• 3. Schauer PR, Bhatt DL, Kirwan JP et al. Bariatric surgery versus intensive medical therapy for diabetes 5 year outcomes. N Engl J Med. 2017;376:641–651.
• 4. Gagner M. Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus. JAMA Surg. 2015;150(10):940-940.
• 5. Øvrebø B, Strømmen M, Kulseng B, Martins C. Bariatric surgery versus lifestyle interventions for severe obesity: 5-year changes in body weight, risk factors and comorbidities. Clin Obes. 2017;7(3):183-190.
• 6. The American Society for Metabolic and Bariatric Surgery (ASMBS). Estimate of Bariatric Surgery Numbers, 2011-2018. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Erişim tarihi:20.07.2020
• 7. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update— Cosponsored by American Association of clinical endocrinologists, the Obesity Society and American Society for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2013;9(2):159-191.
• 8. Schiavo, L. Scalera, G. Pilone, V. De Sena, G. Ciorra, F.R. Barbarisi, A. Patient adherence in following a prescribed diet and micronutrient supplements after laparoscopic sleeve gastrectomy: Our experience during 1 year of follow-up. J. Hum Nutr Diet. 2017;30(1):98–104.
• 9. Pintó, X. Fanlo-Maresma, M. Corbella, E.et al. A Mediterranean Diet rich in extra-virgin olive oil is associated with a reduced prevalence of nonalcoholic fatty liver disease in older individuals at high cardiovascular risk. J Nutr. 2019;149(11):1920-1929.
• 10. de Lorgeril M, Renaud S, Memell N, et al. Mediterranean alpha linolenic acidrich diet in secondary prevention of coronary heart disease. Lancet. 1994;343(8911):1454–1459.
• 11. Brea Á, Pintó X, Ascaso JF et al. Nonalcoholic fatty liver disease, association with cardiovascular disease and treatment. (I). Nonalcoholic fatty liver disease and its Association with cardiovascular disease. Clin Investig Arterioscler. 2017;29:141-148.
• 12. Schiavo L, Scalera G, Sergio R, De Sena G, Pilone V, Barbarisi A . Clinical impact of Mediterranean-enriched-protein diet on liver size, visceral fat, fat mass, and fat-free mass in patients undergoing sleeve gastrectomy. Surg Obes Relat Dis.2015;11(5):1164–1170.
• 13. Uylaşer V, Yildiz G. The historical development and nutritional importance of olive and olive oil constituted an important part of the Mediterranean diet.Crit Rev Food Sci Nutr. 2014;54(8):1092–1101.
• 14. Wree A, Broderick L, Canbay A, et al. From NAFLD to NASH to cirrhosis – new insights into disease mechanims. Nat Rev Gastroenterol Hepatol. 2013;10(11):627–636.
• 15. McCarthy EM, Rinella ME. The role of diet and nutrient composition in nonalcoholic fatty liver disease.J Acad Nutr Diet. 2012;112(3):401–409. 16. Kesse-Guyot E, Ahluwalia N, Lassale C, et al. Adherence to mediterranean diet reduces the risk of metabolic syndrome:A 6-year prospective study. Nutr Metab Cardiovasc Dis. 2013; 23(7):677–683.
• 17. Grosso G, Pajak A, Mistretta A, et al. Protective role of the Mediterranean diet on several cardiovascular risk factors: Evidence from Sicily, southern Italy. Nutr Metab Cardiovasc Dis. 2014;24(4):370–377.
• 18. Mathurin P, Gonzalez F, Kerdraon O, et al. The evolution of severe steatosis after bariatric surgery is related to insulin resistance. Gastroenterology. 2006;130(6):1617-1624.
• 19. Kral JG, Sjostrom LV, Sullivan MB. Assessment of quality of life before and after surgery for severe obesity. Am J Clin Nutr. 1992;55(2):611–614.
• 20. Sjostrom CD, Lissner L, Wedel H, Sjostrom L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res.1999;7(5):477–484.
• 21. Lassailly G, Caiazzo R, Buob D et al. Bariatric surgery reduces features of non-alcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149(2):377-388.