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British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update.
O'Kane, M, Parretti, HM, Pinkney, J, Welbourn, R, Hughes, CA, Mok, J, Walker, N, Thomas, D, Devin, J, Coulman, KD, et al
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2020;21(11):e13087
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Plain language summary
All bariatric surgery procedures impact on nutrition to varying degrees and can potentially cause clinically significant deficiencies of micronutrients. The British Obesity and Metabolic Surgery Society (BOMSS) published its first nutritional guidelines in 2014. In fact, the aim of this document is to systematically review the current evidence for preoperative and postoperative biochemical monitoring and micronutrient replacement for adolescents and adults undergoing bariatric surgery, and to update the recommendations for safe practice in the U.K. setting. One hundred and thirty-nine papers were included in the review. Results show that following surgery, the risk of nutritional deficiencies increases because of the impact of bariatric surgery on both oral intake and absorption. Thus, preoperative care should include: - a comprehensive nutritional assessment prior to bariatric surgery, - a clinically investigative and corrective approach of nutritional deficiencies before surgery, - preparatory support and education by a dietitian, and - guidance on following a low calorie/low carbohydrate diet. Whereas, postoperative care should include access to lifelong monitoring following bariatric surgery to ensure that nutritional requirements are met, and risks of developing post-bariatric surgery related nutritional deficiencies are reduced. Authors conclude that these guidelines have the potential to improve clinical practice and safety for people undergoing bariatric surgery and should be considered for adoption by healthcare organizations.
Abstract
Bariatric surgery is recognized as the most clinically and cost-effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre-existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non-specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive, encompassing preoperative and postoperative biochemical monitoring, vitamin and mineral supplementation and correction of nutrition deficiencies before, and following bariatric surgery, and make recommendations for safe clinical practice in the U.K. setting.
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Nutritional Interventions to Improve Clinical Outcomes in Ovarian Cancer: A Systematic Review of Randomized Controlled Trials.
Rinninella, E, Fagotti, A, Cintoni, M, Raoul, P, Scaletta, G, Quagliozzi, L, Miggiano, GAD, Scambia, G, Gasbarrini, A, Mele, MC
Nutrients. 2019;11(6)
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Ovarian cancer is one of the most common cancers worldwide and it has the highest mortality rate of all gynaecologic cancers. The aim of the study was to examine the impact of several types of nutrition interventions on clinical outcomes in ovarian cancer patients. The study is a systemic review of fourteen randomised controlled trials (RCTs) focusing on nutritional interventions during chemotherapy or during the perioperative period. The majority of RCTs reported improved clinical outcomes after nutritional interventions. Most RCTs show a reduction in length of hospital stay and ameliorated intestinal recovery after surgery. Authors conclude that it is important to find nutritional interventions in order to improve patient’s survival since the ovarian mortality rate is one of the highest among malignancies.
Abstract
Among all gynaecological neoplasms, ovarian cancer has the highest rate of disease-related malnutrition, representing an important risk factor of postoperative mortality and morbidity. Hence, the importance of finding effective nutritional interventions is crucial to improve ovarian cancer patient's well-being and survival. This systematic review of randomized controlled trials (RCTs) aims at assessing the effects of nutritional interventions on clinical outcomes such as overall survival, progression-free survival, length of hospital stay (LOS), complications following surgery and/or chemotherapy in ovarian cancer patients. Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until December 2018. A total of 14 studies were identified. Several early postoperative feeding interventions studies (n = 8) were retrieved mainly demonstrating a reduction in LOS and an ameliorated intestinal recovery after surgery. Moreover, innovative nutritional approaches such as chewing gum intervention (n = 1), coffee consumption (n = 1), ketogenic diet intervention (n = 2) or fruit and vegetable juice concentrate supplementation diet (n = 1) and short-term fasting (n = 1) have been shown as valid and well-tolerated nutritional strategies improving clinical outcomes. However, despite an acceptable number of prospective trials, there is still a lack of homogeneous and robust endpoints. In particular, there is an urgent need of RCTs evaluating overall survival and progression-free survival during ovarian oncology treatments. Further high-quality studies are warranted, especially prospective studies and large RCTs, with more homogeneous types of intervention and clinical outcomes, including a more specific sampling of ovarian cancer women, to identify appropriate and effective nutritional strategies for this cancer, which is at high risk of malnutrition.