Ana Raquel Marques1,2, Carolina B Lobato1,2, Sofia S Pereira1,2, Marta Guimarães1,2,3, Sandra Faria3, Mário Nora1,3, Mariana P Monteiro4,5. 1. Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal. 2. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal. 3. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal. 4. Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal. mpmonteiro@icbas.up.pt. 5. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal. mpmonteiro@icbas.up.pt.
Abstract
BACKGROUND/AIM: The need to improve post-bariatric hypoglycemia (PBH) diagnosis and clinical management is well recognized. Our aim was to evaluate the influence of meal nutritional composition on interstitial fluid glucose (IFG) profiles and symptom profile after Roux-en-Y gastric bypass (RYGB). METHODS: Seventeen subjects previously submitted to RYGB were allocated into two groups of symptomatic (n = 9) or control individuals (n = 8), according to spontaneous report of symptoms suggestive of hypoglycemia. Subjects were provided with a food and symptom diary (FSD) to record dietary intake and symptoms experienced, while using a flash glucose monitoring (FGM) system for 14 days. RESULTS: Postprandial symptom reports occurred in 70.5% of subjects (88.9% vs 50.0%, p = 0.0790, symptomatic vs control), although symptoms with concurrent IFG < 54 mg/dL and within 54 to 69 mg/dL were only observed in 31.9% and 4.8% of the events in the symptomatic vs control group, respectively (p = 0.0110). Daily glucose profiles, total energy, and macronutrients intake were not significantly different between the groups. However, nutritional composition of meals preceding reported symptoms had lower protein (3.2 g ± 1.0 g vs 7.7 g ± 0.5 g, p = 0.0286) or higher sugar (11.6 g ± 2.4 g vs 4.3 g ± 0.9 g, p = 0.0333) content. CONCLUSIONS: Postprandial symptoms are often in patients after RYGB. Concurrent hypoglycemia only occurs in up to a third of the symptomatic episodes being more frequent in patients that spontaneously reported complaints. Hypoglycemia is more likely to be triggered by meals with a low protein or high sugar content. These findings highlight the putative role of meal composition in eliciting PBH and reinforce the need to refine nutritional intervention.
BACKGROUND/AIM: The need to improve post-bariatric hypoglycemia (PBH) diagnosis and clinical management is well recognized. Our aim was to evaluate the influence of meal nutritional composition on interstitial fluid glucose (IFG) profiles and symptom profile after Roux-en-Y gastric bypass (RYGB). METHODS: Seventeen subjects previously submitted to RYGB were allocated into two groups of symptomatic (n = 9) or control individuals (n = 8), according to spontaneous report of symptoms suggestive of hypoglycemia. Subjects were provided with a food and symptom diary (FSD) to record dietary intake and symptoms experienced, while using a flash glucose monitoring (FGM) system for 14 days. RESULTS: Postprandial symptom reports occurred in 70.5% of subjects (88.9% vs 50.0%, p = 0.0790, symptomatic vs control), although symptoms with concurrent IFG < 54 mg/dL and within 54 to 69 mg/dL were only observed in 31.9% and 4.8% of the events in the symptomatic vs control group, respectively (p = 0.0110). Daily glucose profiles, total energy, and macronutrients intake were not significantly different between the groups. However, nutritional composition of meals preceding reported symptoms had lower protein (3.2 g ± 1.0 g vs 7.7 g ± 0.5 g, p = 0.0286) or higher sugar (11.6 g ± 2.4 g vs 4.3 g ± 0.9 g, p = 0.0333) content. CONCLUSIONS: Postprandial symptoms are often in patients after RYGB. Concurrent hypoglycemia only occurs in up to a third of the symptomatic episodes being more frequent in patients that spontaneously reported complaints. Hypoglycemia is more likely to be triggered by meals with a low protein or high sugar content. These findings highlight the putative role of meal composition in eliciting PBH and reinforce the need to refine nutritional intervention.
Authors: Hafiz Sarwar; William H Chapman; John R Pender; Andrada Ivanescu; Almond J Drake; Walter J Pories; Moahad S Dar Journal: Obes Surg Date: 2014-07 Impact factor: 4.129
Authors: Nam Q Nguyen; Tamara L Debreceni; Carly M Burgstad; Melissa Neo; Max Bellon; Judith M Wishart; Scott Standfield; Dylan Bartholomeusz; Chris K Rayner; Gary Wittert; Michael Horowitz Journal: Obes Surg Date: 2016-01 Impact factor: 4.129
Authors: Zubaidah Nor Hanipah; Suriya Punchai; T Javier Birriel; M Cecilia Lansang; Sangeeta R Kashyap; Stacy A Brethauer; Philip R Schauer; Ali Aminian Journal: Surg Obes Relat Dis Date: 2018-02-28 Impact factor: 4.734
Authors: Sarah Malik; James E Mitchell; Kristine Steffen; Scott Engel; Ron Wiisanen; Luis Garcia; Shahbaz Ali Malik Journal: Obes Res Clin Pract Date: 2015-10-27 Impact factor: 2.288
Authors: Carolina B Lobato; Sofia S Pereira; Marta Guimarães; Bolette Hartmann; Nicolai J Wewer Albrechtsen; Linda Hilsted; Jens J Holst; Mário Nora; Mariana P Monteiro Journal: Front Endocrinol (Lausanne) Date: 2020-11-30 Impact factor: 5.555