Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials
PurposeTo optimize patients prior to bariatric surgery, very low energy diets (VLEDs) are often employed for 2–4 weeks preoperatively. They are known to result in preoperative weight loss, decrease liver volume, and decrease surgeon-perceived operative difficulty. Their impact on postoperative morbi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1211575/full |
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| author | Tyler McKechnie Tyler McKechnie Yung Lee Yung Lee Joanna Dionne Aristithes Doumouras Aristithes Doumouras Aristithes Doumouras Sameer Parpia Mohit Bhandari Mohit Bhandari Cagla Eskicioglu Cagla Eskicioglu |
| author_facet | Tyler McKechnie Tyler McKechnie Yung Lee Yung Lee Joanna Dionne Aristithes Doumouras Aristithes Doumouras Aristithes Doumouras Sameer Parpia Mohit Bhandari Mohit Bhandari Cagla Eskicioglu Cagla Eskicioglu |
| author_sort | Tyler McKechnie |
| collection | DOAJ |
| description | PurposeTo optimize patients prior to bariatric surgery, very low energy diets (VLEDs) are often employed for 2–4 weeks preoperatively. They are known to result in preoperative weight loss, decrease liver volume, and decrease surgeon-perceived operative difficulty. Their impact on postoperative morbidity has been less extensively studied. We performed a focused systematic review and meta-analysis with the aim of comparing preoperative VLEDs prior to bariatric surgery with controls in terms of overall postoperative morbidity.MethodsMEDLINE, Embase, and CENTRAL were searched from database inception to February 2023. Articles were eligible for inclusion if they were randomized controlled trials (RCTs) comparing postoperative morbidity in adult patients (i.e., over the age of 18) receiving a VLED with liquid formulation to those receiving a non-VLED control prior to elective bariatric surgery. Outcomes included overall 30-day postoperative morbidity and preoperative weight loss. An inverse variance meta-analysis was performed with GRADE assessment of the quality of evidence.ResultsAfter reviewing 2,525 citations, four RCTs with 294 patients receiving preoperative VLEDs with liquid formulation and 294 patients receiving a non-VLED control met inclusion. Patients receiving VLED experienced significantly more preoperative weight loss than patients receiving control (mean difference (MD) 3.38 kg, 95% confidence interval (CI) 1.06–5.70, p = 0.004, I2 = 95%). According to low certainty evidence, there was a non-significant reduction in 30-day postoperative morbidity in patients receiving VLED prior to bariatric surgery (risk ratio (RR) 0.67, 95%CI 0.39–1.17, p = 0.16, I2 = 0%).ConclusionThe impact of preoperative VLEDs on postoperative outcomes following bariatric surgery remains unclear. It is possible that VLEDs may contribute to decreased postoperative morbidity, but further larger prospective trials are required to investigate the signal identified in this study. |
| first_indexed | 2024-03-13T04:20:20Z |
| format | Article |
| id | doaj.art-feed95ab5a6948cf879feaa71203afc2 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-03-13T04:20:20Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-feed95ab5a6948cf879feaa71203afc22023-06-20T11:34:26ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-06-011010.3389/fnut.2023.12115751211575Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trialsTyler McKechnie0Tyler McKechnie1Yung Lee2Yung Lee3Joanna Dionne4Aristithes Doumouras5Aristithes Doumouras6Aristithes Doumouras7Sameer Parpia8Mohit Bhandari9Mohit Bhandari10Cagla Eskicioglu11Cagla Eskicioglu12Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaDivision of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaHarvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United StatesDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaDivision of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaDivision of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaDivision of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaDivision of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, CanadaDivision of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, CanadaPurposeTo optimize patients prior to bariatric surgery, very low energy diets (VLEDs) are often employed for 2–4 weeks preoperatively. They are known to result in preoperative weight loss, decrease liver volume, and decrease surgeon-perceived operative difficulty. Their impact on postoperative morbidity has been less extensively studied. We performed a focused systematic review and meta-analysis with the aim of comparing preoperative VLEDs prior to bariatric surgery with controls in terms of overall postoperative morbidity.MethodsMEDLINE, Embase, and CENTRAL were searched from database inception to February 2023. Articles were eligible for inclusion if they were randomized controlled trials (RCTs) comparing postoperative morbidity in adult patients (i.e., over the age of 18) receiving a VLED with liquid formulation to those receiving a non-VLED control prior to elective bariatric surgery. Outcomes included overall 30-day postoperative morbidity and preoperative weight loss. An inverse variance meta-analysis was performed with GRADE assessment of the quality of evidence.ResultsAfter reviewing 2,525 citations, four RCTs with 294 patients receiving preoperative VLEDs with liquid formulation and 294 patients receiving a non-VLED control met inclusion. Patients receiving VLED experienced significantly more preoperative weight loss than patients receiving control (mean difference (MD) 3.38 kg, 95% confidence interval (CI) 1.06–5.70, p = 0.004, I2 = 95%). According to low certainty evidence, there was a non-significant reduction in 30-day postoperative morbidity in patients receiving VLED prior to bariatric surgery (risk ratio (RR) 0.67, 95%CI 0.39–1.17, p = 0.16, I2 = 0%).ConclusionThe impact of preoperative VLEDs on postoperative outcomes following bariatric surgery remains unclear. It is possible that VLEDs may contribute to decreased postoperative morbidity, but further larger prospective trials are required to investigate the signal identified in this study.https://www.frontiersin.org/articles/10.3389/fnut.2023.1211575/fullbariatric surgeryweight lossvery low energy dietvery low calorie dietpostoperative complicationsrandomized controlled trials |
| spellingShingle | Tyler McKechnie Tyler McKechnie Yung Lee Yung Lee Joanna Dionne Aristithes Doumouras Aristithes Doumouras Aristithes Doumouras Sameer Parpia Mohit Bhandari Mohit Bhandari Cagla Eskicioglu Cagla Eskicioglu Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials Frontiers in Nutrition bariatric surgery weight loss very low energy diet very low calorie diet postoperative complications randomized controlled trials |
| title | Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Very low energy diets prior to bariatric surgery may reduce postoperative morbidity: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | very low energy diets prior to bariatric surgery may reduce postoperative morbidity a systematic review and meta analysis of randomized controlled trials |
| topic | bariatric surgery weight loss very low energy diet very low calorie diet postoperative complications randomized controlled trials |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1211575/full |
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