Nutritional assessment and case control study of five year post bariatric surgery patient

Abstract

The study, entitled “Nutritional Assessment and Case-Control Study of Five Year Post-Bariatric Surgery Patients” was conducted in multispecialty hospitals in Thiruvananthapuram, Kerala in the year 2023-2024. This study was conducted as a comprehensive nutritional assessment and a case - control study of patients five years post-bariatric surgery. Anthropometric data analysis showed significant reductions in weight (114.05 ± 22.01 to 87.74 ± 14.75 kg), Body Mass Index (BMI) ( 42.41 ± 6.54 to 32.70 ± 4.44 kg/m²), and waist circumference (126.8 ± 9.71 to 113.51 ± 10.01 cm) following bariatric surgery, particularly within the first year post-surgery at (p < 0.01) level of significance. Clinical and biochemical improvements were also observed, with significant reductions in blood pressure (153.6 to 128.08mmHg), pulse rate (78.8-71.68 bpm), HbA1c (7.32 6.23%) and blood sugar levels (155.51 to 94.64mg/dL), as well as improvements in lipid profiles. However, slight weight regain was observed beyond the five-year mark, indicating the necessity for continued monitoring and interventions to maintain health outcomes. Despite improvements, deficiencies in key nutrients such as Vitamin D, B1, B3, and B7 were prevalent, highlighting the need for long-term nutritional management and supplementation. These findings demonstrated that most health (skin and hair condition) improvements occur during the early post-operative periods, with benefits sustained over five years. Nutritional analysis indicated a marked improvement in dietary patterns, with increased adherence to a balanced diet, reduced consumption of junk food (36.66 %), and greater reliance on nutrient-rich food groups. However, some variability in food consumption patterns and gaps in nutritional awareness were noted, suggesting the need for targeted educational interventions. The study also highlighted a shift towards home cooking and a decrease in eating out, reflecting positive changes in dietary behaviours post-surgery. However, an increase in food intolerances, particularly to milk (5%), eggs (5%), and meat (3.33%), was observed, which might require further dietary adjustments. 243 The study also examined the food preferences, dietary behaviours, health outcomes, physical activity patterns, and quality of life among bariatric surgery patients over a five-year period. The results highlighted slightly shifts in dietary preferences post surgery, with a slight increase in vegetarianism immediately following surgery, though the majority of respondents eventually reverted to pre-surgery dietary habits. Cooking methods favoured by respondents were predominantly (90%) boiling and steaming, while preferences for fresh (85%), minimally processed foods were notable, with a marked aversion to fried (25%) and deep-fried (23.33%) foods. These findings underscore the importance of long-term nutritional counselling to sustain healthy eating patterns after bariatric surgery. Regarding health outcomes, bariatric surgery led to substantial improvements in conditions such as diabetes decrease symptom (45%), hypertension symptom (56.66%), snoring (55%), PCOD (20%), hyperlipidaemia (25%), obstructive sleep apnea (11.66%), depression and anxiety (11.67), and joint pains (10%). However, some conditions, including hypertension, snoring, and GERD, showed signs of recurrence over time, suggesting that long-term management and follow-up are essential to address evolving health challenges. Notably, emotional and psychological issues, such as depression and anxiety, showed initial improvement but experienced a resurgence after five years, highlighting the need for continuous emotional support and mental health monitoring. In terms of physical activity, while many respondents experienced increased engagement in physical activities, a significant portion still led sedentary lifestyles (53.33%). The study found that bariatric surgery positively influenced physical activity levels, but efforts to reduce sedentary behaviours and promote longer exercise durations was felt needed in post-surgery care. The quality of life assessment revealed generally positive outcomes, with respondents reporting high satisfaction with their health (48.33%), family relationships (85%), and social engagement (60%). However, physical activity limitations and mental well-being presented challenges for some individuals, indicating that post-surgery quality of life could be further enhanced by addressing these aspects. 244 The case control study results indicate that while most anthropometric, biochemical, and clinical parameters did not show statistically signidficant changes within the one-month timeframe, the controlled group demonstrated notable improvements in symptom management (diabetes, GERD, and PCOD) and significant reductions in energy intake. Additionally, the controlled group exhibited superior nutritional knowledge, which may contribute to better long-term dietary habits and health outcomes. These findings underscore the importance of nutritional education and dietary interventions as complementary strategies for managing weight and improving health, particularly when combined with a structured control approach. Longer-term studies may be required to observe significant changes in biochemical and clinical parameters. Bariatric surgery significantly enhances weight loss, clinical outcomes, and quality of life, particularly for conditions such as diabetes, GERD, and PCOD, while also highlighting challenges like nutrient deficiencies and food intolerances. The findings emphasize the importance of comprehensive, multidisciplinary post-surgical care to address recurring health conditions and emotional well-being. Nutritional education and structured dietary interventions proved critical for improving symptom management and fostering sustained behavioural changes. Superior outcomes in the controlled group demonstrated the efficacy of targeted interventions in reducing energy intake and enhancing health. These insights underscore the need for longitudinal research to refine personalized care strategies and optimize long-term outcomes.