Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom.
Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom.
J Nutr. 2022 Nov;152(11):2319-2332. doi: 10.1093/jn/nxac164. Epub 2022 Jul 23.
Lack of robust research methodology for assessing ingestive behavior has impeded clarification of the mediators of food intake following gastric bypass (GBP) surgery.
To evaluate changes in directly measured 24-h energy intake (EI), energy density (ED) (primary outcomes), eating patterns, and food preferences (secondary outcomes) in patients and time-matched weight-stable comparator participants.
Patients [n = 31, 77% female, BMI (in kg/m) 45.5 ± 1.3] and comparators (n = 32, 47% female, BMI 27.2 ± 0.8) were assessed for 36 h under fully residential conditions at baseline (1 mo presurgery) and at 3 and 12 mo postsurgery. Participants had ad libitum access to a personalized menu (n = 54 foods) based on a 6-macronutrient mix paradigm. Food preferences were assessed by the Leeds Food Preference Questionnaire. Body composition was measured by whole-body DXA.
In the comparator group, there was an increase in relative fat intake at 3 mo postsurgery; otherwise, no changes were observed in food intake or body composition. At 12 mo postsurgery, patients lost 27.7 ± 1.6% of initial body weight (P < 0.001). The decline in EI at 3 mo postsurgery (-44% from baseline, P < 0.001) was followed by a partial rebound at 12 mo (-18% from baseline), but at both times, dietary ED and relative macronutrient intake remained constant. The decline in EI was due to eating the same foods as consumed presurgery and by decreasing the size (g, MJ), but not the number, of eating occasions. In patients, reduction in explicit liking at 3 mo (-11.56 ± 4.67, P = 0.007) and implicit wanting at 3 (-15.75 ± 7.76, P = 0.01) and 12 mo (-15.18 ± 6.52, P = 0.022) for sweet foods were not matched by reduced intake of these foods. Patients with the greatest reduction in ED postsurgery reduced both EI and preference for sweet foods.
After GBP, patients continue to eat the same foods but in smaller amounts. These findings challenge prevailing views about the dynamics of food intake following GBP surgery. This trial was registered as clinicaltrials.gov as NCT03113305.
缺乏评估胃旁路（GBP）手术后摄食行为的稳健研究方法，阻碍了对食物摄入的中介因素的澄清。
评估患者（n=31，77%女性，BMI[kg/m]45.5±1.3）和时间匹配的体重稳定对照参与者（n=32，47%女性，BMI 27.2±0.8）直接测量的 24 小时能量摄入（EI）和能量密度（ED）（主要结局）、进食模式和食物偏好（次要结局）的变化。
在基线（手术前 1 个月）和手术后 3 个月和 12 个月，患者和对照组参与者在完全居住条件下接受 36 小时评估。参与者可以根据 6 种宏量营养素混合模式自由选择个性化菜单（n=54 种食物）。通过利兹食物偏好问卷评估食物偏好。全身 DXA 测量身体成分。
在对照组中，术后 3 个月脂肪摄入相对增加；否则，食物摄入或身体成分没有变化。术后 12 个月，患者体重减轻初始体重的 27.7±1.6%（P<0.001）。术后 3 个月 EI 的下降（比基线下降 44%，P<0.001）随后在 12 个月时部分反弹（比基线下降 18%），但在这两个时间点，饮食 ED 和相对宏量营养素摄入保持不变。EI 的下降是由于摄入与术前相同的食物，并减少了进食次数（g、MJ），而不是数量。在患者中，术后 3 个月时对甜味食物的明确喜好（-11.56±4.67，P=0.007）和隐含偏好（-15.75±7.76，P=0.01）以及 12 个月时（-15.18±6.52，P=0.022）的下降并没有被这些食物摄入量的减少所匹配。术后 ED 下降最大的患者同时减少了 EI 和对甜味食物的偏好。
GBP 后，患者继续食用相同的食物，但数量减少。这些发现挑战了关于 GBP 手术后食物摄入动态的普遍观点。本试验在 clinicaltrials.gov 上注册为 NCT03113305。
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