Journal of the Korean Dietetic Association (대한영양사협회학술지)

The Korean Dietetic Association (대한영양사협회)
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Medical-Nutrition-Therapy for Obese Patients with Type 2 Diabetes Mellitus Undergoing Metabolic Surgery

제2형 당뇨비만환자의 수술요법 시 임상영양치료 프로토콜 설정

  • Kim, Hye-Jin (Dept. of Nutrition, Yeouido St. Mary's Hospital, Catholic University) ;
  • NamGung, Sin-A (Dept. of Nutrition, Yeouido St. Mary's Hospital, Catholic University) ;
  • Hong, Jeong-Im (Dept. of Nutrition, Yeouido St. Mary's Hospital, Catholic University) ;
  • Mok, Hee-Jung (Dept. of Nutrition, Yeouido St. Mary's Hospital, Catholic University)
  • 김혜진 (가톨릭대학교 여의도성모병원 영양팀) ;
  • 남궁신아 (가톨릭대학교 여의도성모병원 영양팀) ;
  • 홍정임 (가톨릭대학교 여의도성모병원 영양팀) ;
  • 목희정 (가톨릭대학교 여의도성모병원 영양팀)
  • Received : 2011.03.02
  • Accepted : 2011.04.08
  • Published : 2011.05.02
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Abstract

Currently, metabolic surgery (Laparoscopic Roux-en-Y gastric bypass, LRYGB) has an important role and should be recommended as an intervention in the management of obese patients with type 2 diabetes mellitus (T2DM). A successful outcome of surgery requires medical nutrition therapy. Therefore, we performed a retrospective study on 25 patients with T2DM who underwent LRYGB at Yeouido St. Mary's Hospital from October 2008 to May 2010. The patients were followed up for an average of 6 months after surgery (range: 2~19 months). Diabetes was resolved in 80% of the patients. Percentage of excess weight loss was (%EWL) was 56.2%. After surgery, fasting blood sugar (FBS) and HbA1c were significantly reduced (123 mg/dl, A1c 6.7%, P<0.001) and triglyceride was also significantly reduced to 107.6 mg/dl (P<0.05). As diets of the patients progressed from liquid to soft to regular diet, energy, carbohydrates, and fat intakes increased significantly (P<0.001). But protein intake did not change significantly. Nutrient intake of the patients after the surgery was significantly lower than the recommended diet for the non-surgery group. Patients experienced side-effects related to the diets after surgery, including hair-loss (76%), smelly gas (52%), vomiting (48%), etc. A significantly positive correlation was observed between vomiting and FBS (P<0.001). There was a significant relationship between side effects and the amount of nutrient intakes. Therefore, guide patients to a diet progression with treatment to minimize side effects, especially vomiting. And monitor their dietary life to be healthy and not to regain weight until remission of T2DM.

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References

  1. 대한당뇨병학회 (2010). Available from: http://www.diabetes.or.kr. Accessed January 21, 2011
  2. ADA. American Diabetes Association. Available from: http:// www.diabetes.org. Accessed January 12, 2011
  3. ADA. American Dietetic Association. Available from: http:// www.eatright.org Accessed January 12, 2011
  4. ASMBS. American Society for Metabolic & Bariatric Surgery. Available from: http://www.asmbs.org. Accessed January 21, 2011
  5. Berg AH, Combs TP, Scherer PE (2002): ACRP30/adiponectin: an adipokine regulating glucose and lipid metabolism. Trends Endocrinol Metab 13(2):84-89 https://doi.org/10.1016/S1043-2760(01)00524-0
  6. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004): Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724-1737 https://doi.org/10.1001/jama.292.14.1724
  7. Dalcanale L, Oliveira CP, Faintuch J, Nogueira MA, Rondó P, Lima VM, Mendonça S, Pajecki D, Mancini M, Carrilho FJ (2010): Long-term nutritional outcome after gastric bypass. Obes Surg 20(2):181-187 https://doi.org/10.1007/s11695-009-9916-5
  8. From the NIH (1980): Successful diet and exercise therapy is conducted in Vermont for "diabesity". JAMA 243(6):519-520 https://doi.org/10.1001/jama.1980.03300320015011
  9. Guidone C, Manco M, Valera-Mora E, Iaconelli A, Gniuli D, Mari A, Nanni G, Castagneto M, Calvani M, Mingrone G (2006): Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes 55(7):2025-2031 https://doi.org/10.2337/db06-0068
  10. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C; Endocrine Society (2010): Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 95(11):4823-4843 https://doi.org/10.1210/jc.2009-2128
  11. IDF. International Diabetes Federation. Available from: http://www.idf.org. Accessed January 12, 2011
  12. Isbell JM, Tamboli RA, Hansen EN, Saliba J, Dunn JP, Phillips SE, Marks-Shulman PA, Abumrad NN (2010): The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care 33(7):1438-1442 https://doi.org/10.2337/dc09-2107
  13. Jazet IM, Pijl H, Frölich M, Romijn JA, Meinders AE (2005): Two days of a very low calorie diet reduces endogenous glucose production in obese type 2 diabetic patients despite the withdrawal of blood glucose-lowering therapies including insulin. Metabolism 54(6):705-712 https://doi.org/10.1016/j.metabol.2004.12.015
  14. Kruseman M, Leimgruber A, Zumbach F, Golay A (2010): Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. J Am Diet Assoc 110(4):527-534 https://doi.org/10.1016/j.jada.2009.12.028
  15. Kulick D, Hark L, Deen D (2010): The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc 110(4):593-599 https://doi.org/10.1016/j.jada.2009.12.021
  16. Lee H, Kim M, Kwon H, Song K, Kim E (2010): The impact of metabolic and bariatric surgery on morbidly obese patients with type 2 DM. J Korean Surg Soc 79(1):8-13 https://doi.org/10.4174/jkss.2010.79.1.8
  17. Leite Faria S, de Oliveira Kelly E, Pereira Faria O, Kiyomi Ito M (2009): Snack-eating patients experience lesser weight loss after Roux-en-Y gastric bypass surgery. Obes Surg 19(9):1293-1296 https://doi.org/10.1007/s11695-008-9704-7
  18. Ribeiro AG, Costa MJ, Faintuch J, Dias MC (2009): A higher meal frequency may be associated with diminished weight loss after bariatric surgery. Clinics (Sao Paulo) 64(11):1053-1058 https://doi.org/10.1590/S1807-59322009001100004
  19. Rubino F, Kaplan LM, Schauer PR, Cummings DE; Diabetes Surgery Summit Delegates (2010): The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 251(3):399-405 https://doi.org/10.1097/SLA.0b013e3181be34e7
  20. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas- Mitchel E, Rao RH, Kuller L, Kelley D (2003): Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238(4):467-484
  21. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H; Swedish Obese Subjects Study Scientific Group (2004): Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351(26):2683-2693 https://doi.org/10.1056/NEJMoa035622
  22. Strauss BJ, Marks SJ, Growcott JP, Stroud DB, Lo CS, Dixon JB, O'Brien PE (2003): Body composition changes following laparoscopic gastric banding for morbid obesity. Acta Diabetol 40 Suppl 1:S266-S269 https://doi.org/10.1007/s00592-003-0083-1
  23. Sugerman HJ, Wolfe LG, Sica DA, Clore JN (2003): Diabetes and hypertension in severe obesity and effects of gastric bypass- induced weight loss. Ann Surg 237(6):751-756
  24. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY (2006): Epidemic obesity and type 2 diabetes in Asia. Lancet 368(9548):1681-1688 https://doi.org/10.1016/S0140-6736(06)69703-1