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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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Reversing the immune ageing clock: lifestyle modifications and pharmacological interventions.
Duggal, NA
Biogerontology. 2018;19(6):481-496
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Advancing age is accompanied by a compromised ability of older adults to combat bacterial and viral infections, increased risk of autoimmunity, poor vaccination responses and the re-emergence of latent infections. This review discusses current understanding of immunesenescence [the gradual deterioration of our immune system as we get older] and also focuses on lifestyle interventions and therapeutic strategies that have been shown to restore immune functioning in aged individuals. Findings show that: - changes in nutrition and lifestyle can be an effective approach towards improving immune outcome in older adults but may be hard to achieve at a population level. - improving immune responses, such as the developments of vaccines, may be used as an early biomarker for anti-ageing effects. Authors conclude that immunomodulation represents a promising therapeutic approach to improve the health of older adults.
Abstract
It is widely accepted that ageing is accompanied by remodelling of the immune system, including reduced numbers of naïve T cells, increased senescent or exhausted T cells, compromise to monocyte, neutrophil and natural killer cell function and an increase in systemic inflammation. In combination these changes result in increased risk of infection, reduced immune memory, reduced immune tolerance and immune surveillance, with significant impacts upon health in old age. More recently it has become clear that the rate of decline in the immune system is malleable and can be influenced by environmental factors such as physical activity as well as pharmacological interventions. This review discusses briefly our current understanding of immunesenescence and then focuses on lifestyle interventions and therapeutic strategies that have been shown to restore immune functioning in aged individuals.