- Email: [email protected]
Limited Food Budget Affects Weight Loss Outcomes After Bariatric Surgery in an Appalachian Population
S170
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
Protein 12%, High fat/sugary foods 8%. The compliance of patients with the 'eat well plate' is not known. Also the effect of dietary advise intervention in the form of regular dietician review prior to surgery on the patient's eating habits and weight loss is poorly understood. Studies have reported change in food preferences and taste patterns after bariatric surgery. Methods: 112 patients referred for bariatric surgery were surveyed about the percentage composition of their dietary intake using the 'eat well plate' to obtain a baseline consumption of fruit & vegetable, carbohydrate, dairy, protein, and sugar & fat intake. Data of 45 patients from this group who had received dietary intervention in the form of dietician advise on the ideal diet composition prior to surgery and the resultant change in their portion composition were analysed. The change in dietary composition at the first clinic review 6-8 weeks after surgery in 14 patients were also analysed. Diet composition was converted to percentages and analysed as ordinal data with statistical analyses performed using GraphPad (Prism) software. Results: In the 112 patients (Age:43 {19-76}; M:F ¼ 44:78; Weight: 135.5 {86.9 - 250}; BMI :47.1 {35.2 - 71}, the mean dietary composition at presentation was 19.4% (sd⫾14.1) for fruit & vegetable, 28.9% (sd⫾15.4) for carbohydrate, 12.3% (sd⫾8.7) for dairy, 20.5% (sd⫾10.4) for protein, 18.9% (sd⫾15.6) sugar & fat. The consumption of fruit & vegetable (po0.0001), carbohydrate (p¼0.001) and dairy products were significantly lower (po0.0001) and the consumption of proteins (po0.0001) and sugar & fat (po0.0001) were significantly higher than the recommended levels (One sample T- test). Of the 45 patients who had dietary advice pre-operatively (Mean 3 consultations ; range 2-6), there was a significant increase in proportion of fruit and vegetables (mean¼13.1%; p¼0.0001), dairy products (mean¼3.2%; p¼0.02 ) and protein (mean¼5.1%; p¼0.001; Wilcoxon-signed-rank test). This was accompanied by a decrease in consumption of carbohydrates (mean¼10.8%; po0.0001), as well as sugar & fat (mean¼10.1%; po0.0001; Wilcoxon-signed rank). Over this same time period the weight of these patients showed a significant mean reduction of 5.3kg (95% CI 3.8-6.9); po0.0001 (paired t-test). Of the 14 patients on whom data at first post operative follow up regarding dietary composition is available, a significant reduction was noted in sugar and fat composition post-operatively compared to pre-op baseline composition (CHI-squared test statistic¼17.18; p¼0.0002 (Friedman test)). Other changes in dietary composition were non-significant. Conclusion: Pre-operative dietician input appears to help in the alteration of dietary composition in bariatric patients pre-surgery which may contribute to weight loss pre-op. The change in sugar and fat composition after surgery is interesting as it lends credence to the suggestion that surgery alters the gustatory and taste preferences of patients which may have an impact on weight loss after surgery.
A5187
LIMITED FOOD BUDGET AFFECTS WEIGHT LOSS OUTCOMES AFTER BARIATRIC SURGERY IN AN APPALACHIAN POPULATION Kaitlin Mock1; Stephanie Cox1; Sara Bias1; Kristin Grogg2; Kiley Iams1; Courtney Brown1; Forrest Olgers3; Jessica Murray1; Cassie Brode1; Lawrence Tabone2; 1West Virginia University
Medicine, Morgantown West Virginia; 2West Virginia University, Morgantown West Virginia; 3West Virginia University Medicine, reedsville wv Background: Living in a rural Appalachian community can be limiting in food availability and variety. Furthermore, job opportunities are less numerous in rural Appalachian areas, resulting in less employment and more families living on limited income. The effects of residing in a rural Appalachian environment on weight loss surgical outcomes are not well defined. Methods: We retrospectively reviewed bariatric surgeries performed in a university hospital in West Virginia from 10/2013 to 02/2015. Type of surgery, pre-operative weight, percent excess weight loss (%EWL) at 3 and 12 months post-operatively, and patient report of employment status and limited food budget at program start were collected. Significant differences among responses were determined by t-test. Results: 34 patients were reviewed for limited food budget, of these, 30 had Roux-en-Y Gastric Bypass (RYGB) surgery and 4 had Sleeve Gastrectomy (SG). 32 patients were further reviewed for employment upon entrance into the program; 28 had RYGB and 4 had SG. Patient report of limited food budget significantly reduced 3 months post op %EWL (p¼0.02), but not 12 months post op %EWL (p¼0.22). However, patient employment status at program entry had no correlation to 3 month and 12 month post op %EWL (p¼0.12 and p¼0.27, respectively). Conclusions: Rural bariatric patients in an Appalachian region have decreased food availability, which is further exacerbated by limited income, but not employment status. These factors influence postoperative weight loss. This study highlights the need for more individualized nutrition education for lower income bariatric surgery patients to strive for equal weight loss outcomes.
A5188
THE INCIDENCE OF IRON DEFICIENCY POST ROUXEN-Y GASTRIC BYPASS AND SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW Ghada Enani1; Krista Hardy1; Elif Bilgic2; Megan Delisle1; Ashley Vergis1; 1University of Manitoba, Department of General Surgery, Winnipeg Manitoba; 2Henry K.M. DeKuyper Education Centre, McGill University, Montreal QC Introduction: Bariatric surgery provides effective long-term treatment of obesity and its associated comorbidities. The physiological and anatomical changes that occur as a consequence of surgery result in macro- and micro-nutritional deficiencies. Iron deficiency is one of the most common deficiencies post-bariatric surgery. It is important to quantify its risk in order to facilitate counseling, monitoring and treatment for bariatric surgery patients. Aim: The aim of this systematic review is to quantify the impact of bariatric surgery on the incidence of iron deficiency. Data SourceDatabases including Ovid Medline, Ovid Embase, Helthstar, Scopus, Cochrane (CDSR), LILACS, DynaMEd, ClinicalKey, TRIPþ, OTSeeker, Johanne Briggs Institute, AMED were searched for original articles. An additional snowballing search was undertaken. Search terms included Obesity, Nutrient deficiency, Iron deficiency, Iron deficiency anemia, Bariatric surgery, Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Studies were included if they described outcomes for Roux-en-Y
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
Protein 12%, High fat/sugary foods 8%. The compliance of patients with the 'eat well plate' is not known. Also the effect of dietary advise intervention in the form of regular dietician review prior to surgery on the patient's eating habits and weight loss is poorly understood. Studies have reported change in food preferences and taste patterns after bariatric surgery. Methods: 112 patients referred for bariatric surgery were surveyed about the percentage composition of their dietary intake using the 'eat well plate' to obtain a baseline consumption of fruit & vegetable, carbohydrate, dairy, protein, and sugar & fat intake. Data of 45 patients from this group who had received dietary intervention in the form of dietician advise on the ideal diet composition prior to surgery and the resultant change in their portion composition were analysed. The change in dietary composition at the first clinic review 6-8 weeks after surgery in 14 patients were also analysed. Diet composition was converted to percentages and analysed as ordinal data with statistical analyses performed using GraphPad (Prism) software. Results: In the 112 patients (Age:43 {19-76}; M:F ¼ 44:78; Weight: 135.5 {86.9 - 250}; BMI :47.1 {35.2 - 71}, the mean dietary composition at presentation was 19.4% (sd⫾14.1) for fruit & vegetable, 28.9% (sd⫾15.4) for carbohydrate, 12.3% (sd⫾8.7) for dairy, 20.5% (sd⫾10.4) for protein, 18.9% (sd⫾15.6) sugar & fat. The consumption of fruit & vegetable (po0.0001), carbohydrate (p¼0.001) and dairy products were significantly lower (po0.0001) and the consumption of proteins (po0.0001) and sugar & fat (po0.0001) were significantly higher than the recommended levels (One sample T- test). Of the 45 patients who had dietary advice pre-operatively (Mean 3 consultations ; range 2-6), there was a significant increase in proportion of fruit and vegetables (mean¼13.1%; p¼0.0001), dairy products (mean¼3.2%; p¼0.02 ) and protein (mean¼5.1%; p¼0.001; Wilcoxon-signed-rank test). This was accompanied by a decrease in consumption of carbohydrates (mean¼10.8%; po0.0001), as well as sugar & fat (mean¼10.1%; po0.0001; Wilcoxon-signed rank). Over this same time period the weight of these patients showed a significant mean reduction of 5.3kg (95% CI 3.8-6.9); po0.0001 (paired t-test). Of the 14 patients on whom data at first post operative follow up regarding dietary composition is available, a significant reduction was noted in sugar and fat composition post-operatively compared to pre-op baseline composition (CHI-squared test statistic¼17.18; p¼0.0002 (Friedman test)). Other changes in dietary composition were non-significant. Conclusion: Pre-operative dietician input appears to help in the alteration of dietary composition in bariatric patients pre-surgery which may contribute to weight loss pre-op. The change in sugar and fat composition after surgery is interesting as it lends credence to the suggestion that surgery alters the gustatory and taste preferences of patients which may have an impact on weight loss after surgery.
A5187
LIMITED FOOD BUDGET AFFECTS WEIGHT LOSS OUTCOMES AFTER BARIATRIC SURGERY IN AN APPALACHIAN POPULATION Kaitlin Mock1; Stephanie Cox1; Sara Bias1; Kristin Grogg2; Kiley Iams1; Courtney Brown1; Forrest Olgers3; Jessica Murray1; Cassie Brode1; Lawrence Tabone2; 1West Virginia University
Medicine, Morgantown West Virginia; 2West Virginia University, Morgantown West Virginia; 3West Virginia University Medicine, reedsville wv Background: Living in a rural Appalachian community can be limiting in food availability and variety. Furthermore, job opportunities are less numerous in rural Appalachian areas, resulting in less employment and more families living on limited income. The effects of residing in a rural Appalachian environment on weight loss surgical outcomes are not well defined. Methods: We retrospectively reviewed bariatric surgeries performed in a university hospital in West Virginia from 10/2013 to 02/2015. Type of surgery, pre-operative weight, percent excess weight loss (%EWL) at 3 and 12 months post-operatively, and patient report of employment status and limited food budget at program start were collected. Significant differences among responses were determined by t-test. Results: 34 patients were reviewed for limited food budget, of these, 30 had Roux-en-Y Gastric Bypass (RYGB) surgery and 4 had Sleeve Gastrectomy (SG). 32 patients were further reviewed for employment upon entrance into the program; 28 had RYGB and 4 had SG. Patient report of limited food budget significantly reduced 3 months post op %EWL (p¼0.02), but not 12 months post op %EWL (p¼0.22). However, patient employment status at program entry had no correlation to 3 month and 12 month post op %EWL (p¼0.12 and p¼0.27, respectively). Conclusions: Rural bariatric patients in an Appalachian region have decreased food availability, which is further exacerbated by limited income, but not employment status. These factors influence postoperative weight loss. This study highlights the need for more individualized nutrition education for lower income bariatric surgery patients to strive for equal weight loss outcomes.
A5188
THE INCIDENCE OF IRON DEFICIENCY POST ROUXEN-Y GASTRIC BYPASS AND SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW Ghada Enani1; Krista Hardy1; Elif Bilgic2; Megan Delisle1; Ashley Vergis1; 1University of Manitoba, Department of General Surgery, Winnipeg Manitoba; 2Henry K.M. DeKuyper Education Centre, McGill University, Montreal QC Introduction: Bariatric surgery provides effective long-term treatment of obesity and its associated comorbidities. The physiological and anatomical changes that occur as a consequence of surgery result in macro- and micro-nutritional deficiencies. Iron deficiency is one of the most common deficiencies post-bariatric surgery. It is important to quantify its risk in order to facilitate counseling, monitoring and treatment for bariatric surgery patients. Aim: The aim of this systematic review is to quantify the impact of bariatric surgery on the incidence of iron deficiency. Data SourceDatabases including Ovid Medline, Ovid Embase, Helthstar, Scopus, Cochrane (CDSR), LILACS, DynaMEd, ClinicalKey, TRIPþ, OTSeeker, Johanne Briggs Institute, AMED were searched for original articles. An additional snowballing search was undertaken. Search terms included Obesity, Nutrient deficiency, Iron deficiency, Iron deficiency anemia, Bariatric surgery, Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Studies were included if they described outcomes for Roux-en-Y