Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes
Background: Ketogenic diet-induced weight loss before bariatric surgery (BS) has beneficial effects on the reduction in the liver volume, metabolic profile, and intra- and post-operative complications. However, these beneficial effects can be limited by poor dietary adherence. A potential solution i...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Nutrients |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6643/15/6/1492 |
| _version_ | 1797609672723660800 |
|---|---|
| author | Giuseppe Castaldo Luigi Schiavo Imma Pagano Paola Molettieri Aurelio Conte Gerardo Sarno Vincenzo Pilone Luca Rastrelli |
| author_facet | Giuseppe Castaldo Luigi Schiavo Imma Pagano Paola Molettieri Aurelio Conte Gerardo Sarno Vincenzo Pilone Luca Rastrelli |
| author_sort | Giuseppe Castaldo |
| collection | DOAJ |
| description | Background: Ketogenic diet-induced weight loss before bariatric surgery (BS) has beneficial effects on the reduction in the liver volume, metabolic profile, and intra- and post-operative complications. However, these beneficial effects can be limited by poor dietary adherence. A potential solution in patients showing a poor adherence in following the prescribed diet could be represented by enteral nutrition strategies. To date, no studies describe the protocol to use for the efficacy and the safety of pre-operative enteral ketogenic nutrition-based dietary protocols in terms of weight reduction, metabolic efficacy, and safety in patients with obesity scheduled for BS. Aims and scope: To assess the clinical impact, efficacy, and safety of ketogenic nutrition enteral protein (NEP) vs. nutritional enteral hypocaloric (NEI) protocols on patients with obesity candidate to BS. Patients and methods: 31 NEP were compared to 29 NEI patients through a 1:1 randomization. The body weight (BW), body mass index (BMI), waist circumference (WC), hip circumference (HC), and neck circumference (NC) were assessed at the baseline and at the 4-week follow-up. Furthermore, clinical parameters were assessed by blood tests, and patients were asked daily to report any side effects, using a self-administered questionnaire. Results: Compared to the baseline, the BW, BMI, WC, HC, and NC were significantly reduced in both groups studied (<i>p</i> < 0.001). However, we did not find any significative difference between the NEP and NEI groups in terms of weight loss (<i>p</i> = 0.559), BMI (<i>p</i>= 0.383), WC (<i>p</i> = 0.779), and HC (<i>p</i> = 0.559), while a statistically significant difference was found in terms of the NC (NEP, −7.1% vs. NEI, −4%, <i>p</i> = 0.011). Furthermore, we found a significant amelioration of the general clinical status in both groups. However, a statistically significant difference was found in terms of glycemia (NEP, −16% vs. NEI, −8.5%, <i>p</i> < 0.001), insulin (NEP, −49.6% vs. NEI, −17.8%, <i>p</i> < 0.0028), HOMA index (NEP, −57.7% vs. NEI, −24.9%, <i>p</i> < 0.001), total cholesterol (NEP, −24.3% vs. NEI, −2.8%, <i>p</i> < 0.001), low-density lipoprotein (NEP, −30.9% vs. NEI, 1.96%, <i>p</i> < 0.001), apolipoprotein A1 (NEP, −24.2% vs. NEI, −7%, <i>p</i> < 0.001), and apolipoprotein B (NEP, −23.1% vs. NEI, −2.3%, <i>p</i> < 0.001), whereas we did not find any significative difference between the NEP and NEI groups in terms of aortomesenteric fat thickness (<i>p</i> = 0.332), triglyceride levels (<i>p</i> = 0.534), degree of steatosis (<i>p</i> = 0.616), and left hepatic lobe volume (<i>p</i> = 0.264). Furthermore, the NEP and NEI treatments were well tolerated, and no major side effects were registered. Conclusions: Enteral feeding is an effective and safe treatment before BS, with NEP leading to better clinical results than NEI on the glycemic and lipid profiles. Further and larger randomized clinical trials are needed to confirm these preliminary data. |
| first_indexed | 2024-03-11T06:04:42Z |
| format | Article |
| id | doaj.art-e5052a6383f8481cb6af342b41518edf |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T06:04:42Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-e5052a6383f8481cb6af342b41518edf2023-11-17T13:06:32ZengMDPI AGNutrients2072-66432023-03-01156149210.3390/nu15061492Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological ChangesGiuseppe Castaldo0Luigi Schiavo1Imma Pagano2Paola Molettieri3Aurelio Conte4Gerardo Sarno5Vincenzo Pilone6Luca Rastrelli7NutriKeto_LAB UNISA-“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, ItalyDepartment of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyNutriKeto_LAB UNISA-“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, ItalyNutriKeto_LAB UNISA-“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, ItalyNutriKeto_LAB UNISA-“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, ItalyGeneral Surgery and Kidney Transplantation Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, ItalyDepartment of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyNBFC, National Biodiversity Future Center, 90133 Palermo, ItalyBackground: Ketogenic diet-induced weight loss before bariatric surgery (BS) has beneficial effects on the reduction in the liver volume, metabolic profile, and intra- and post-operative complications. However, these beneficial effects can be limited by poor dietary adherence. A potential solution in patients showing a poor adherence in following the prescribed diet could be represented by enteral nutrition strategies. To date, no studies describe the protocol to use for the efficacy and the safety of pre-operative enteral ketogenic nutrition-based dietary protocols in terms of weight reduction, metabolic efficacy, and safety in patients with obesity scheduled for BS. Aims and scope: To assess the clinical impact, efficacy, and safety of ketogenic nutrition enteral protein (NEP) vs. nutritional enteral hypocaloric (NEI) protocols on patients with obesity candidate to BS. Patients and methods: 31 NEP were compared to 29 NEI patients through a 1:1 randomization. The body weight (BW), body mass index (BMI), waist circumference (WC), hip circumference (HC), and neck circumference (NC) were assessed at the baseline and at the 4-week follow-up. Furthermore, clinical parameters were assessed by blood tests, and patients were asked daily to report any side effects, using a self-administered questionnaire. Results: Compared to the baseline, the BW, BMI, WC, HC, and NC were significantly reduced in both groups studied (<i>p</i> < 0.001). However, we did not find any significative difference between the NEP and NEI groups in terms of weight loss (<i>p</i> = 0.559), BMI (<i>p</i>= 0.383), WC (<i>p</i> = 0.779), and HC (<i>p</i> = 0.559), while a statistically significant difference was found in terms of the NC (NEP, −7.1% vs. NEI, −4%, <i>p</i> = 0.011). Furthermore, we found a significant amelioration of the general clinical status in both groups. However, a statistically significant difference was found in terms of glycemia (NEP, −16% vs. NEI, −8.5%, <i>p</i> < 0.001), insulin (NEP, −49.6% vs. NEI, −17.8%, <i>p</i> < 0.0028), HOMA index (NEP, −57.7% vs. NEI, −24.9%, <i>p</i> < 0.001), total cholesterol (NEP, −24.3% vs. NEI, −2.8%, <i>p</i> < 0.001), low-density lipoprotein (NEP, −30.9% vs. NEI, 1.96%, <i>p</i> < 0.001), apolipoprotein A1 (NEP, −24.2% vs. NEI, −7%, <i>p</i> < 0.001), and apolipoprotein B (NEP, −23.1% vs. NEI, −2.3%, <i>p</i> < 0.001), whereas we did not find any significative difference between the NEP and NEI groups in terms of aortomesenteric fat thickness (<i>p</i> = 0.332), triglyceride levels (<i>p</i> = 0.534), degree of steatosis (<i>p</i> = 0.616), and left hepatic lobe volume (<i>p</i> = 0.264). Furthermore, the NEP and NEI treatments were well tolerated, and no major side effects were registered. Conclusions: Enteral feeding is an effective and safe treatment before BS, with NEP leading to better clinical results than NEI on the glycemic and lipid profiles. Further and larger randomized clinical trials are needed to confirm these preliminary data.https://www.mdpi.com/2072-6643/15/6/1492weight lossenteral protein nutritional therapyobesity surgerypreoperative care |
| spellingShingle | Giuseppe Castaldo Luigi Schiavo Imma Pagano Paola Molettieri Aurelio Conte Gerardo Sarno Vincenzo Pilone Luca Rastrelli Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes Nutrients weight loss enteral protein nutritional therapy obesity surgery preoperative care |
| title | Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes |
| title_full | Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes |
| title_fullStr | Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes |
| title_full_unstemmed | Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes |
| title_short | Clinical Impact of Enteral Protein Nutritional Therapy on Patients with Obesity Scheduled for Bariatric Surgery: A Focus on Safety, Efficacy, and Pathophysiological Changes |
| title_sort | clinical impact of enteral protein nutritional therapy on patients with obesity scheduled for bariatric surgery a focus on safety efficacy and pathophysiological changes |
| topic | weight loss enteral protein nutritional therapy obesity surgery preoperative care |
| url | https://www.mdpi.com/2072-6643/15/6/1492 |
| work_keys_str_mv | AT giuseppecastaldo clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT luigischiavo clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT immapagano clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT paolamolettieri clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT aurelioconte clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT gerardosarno clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT vincenzopilone clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges AT lucarastrelli clinicalimpactofenteralproteinnutritionaltherapyonpatientswithobesityscheduledforbariatricsurgeryafocusonsafetyefficacyandpathophysiologicalchanges |