| 1. |
- Hedenbro, Jan, et al.
(författare)
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Formation of the Scandinavian Obesity Surgery Registry, SOReg
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 25:10, s. 1893-1900
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Tidskriftsartikel (refereegranskat)abstract
- Obesity surgery is expanding, the quality of care is ever more important, and learning curve assessment should be established. A large registry cohort can show long-term effects on obesity and its comorbidities, complications, and long-term side effects of surgery, as well as changes in health-related quality of life (QoL). Sweden is ideally suited to the task of data collection and audit, with universal use of personal identification numbers, nation-wide registries permitting cross-matching to analyze causes of death, in-hospital care, and health-related absenteeism. In 2004, the Scandinavian Obesity Surgery Registry (SOReg) was initiated and government financing secured. A project group created a national database covering all public as well as private hospitals. Data entry was to be made online, operative definitions of comorbidity were formed, and complication severity scored. Several forms of audit were devised. After pilot studies, the system has been running in its present form since 2007. Since 15 January 2013, SOReg covers all bariatric surgery centers in Sweden. The number of operations in the database exceeded 40,000 (March 2014), with a median follow-up of 2.94 years. Audit shows that > 98 % of data are correct. All results are publicized annually on the Internet. Using this systematic approach, it has been possible to cover > 99 % of all bariatric surgery, cross-matching our data with nation-wide registries for in-hospital care, cause of death, and permitting regular nation-wide audit. Several scientific studies have used, or are using, what seems to be the most comprehensive database in obesity surgery.
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| 2. |
- Henfridsson, Pia, et al.
(författare)
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Five-year changes in dietary intake and body composition in adolescents with severe obesity undergoing laparoscopic Roux-en-Y gastric bypass surgery
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 15:1, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- Background: Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). Objectives: To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB. Setting: University hospitals, multicenter study, Sweden. Methods: Eighty-five adolescents (67% girls; mean +/- standard deviation, age 16.0 +/- 1.2 yr, body mass index 45.5 +/- 6.1 kg/m(2)) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years. Results: Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P amp;lt; .001) while controls gained 13% over 5 years (P amp;lt; .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P amp;lt; .05). DED decreased at 1 year (P -= .03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P amp;lt; .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P amp;lt; .001). Boys preserved muscle mass more than girls (P amp;lt; .01). Adequate protein intake was associated with preservation of muscle mass (P=.003). Conclusions: In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass. (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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| 3. |
- Henfridsson, Pia, et al.
(författare)
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Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 15:9, s. 1494-1502
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies. Objectives: To assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB. Setting: University hospitals, multicenter study, Sweden. Methods: Micronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (± 1.2) with a body mass index of 45.5 kg/m2 (± 6.0). Adherence was defined as taking prescribed supplements ≥3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years. Results: Over 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44–61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P < .04) and 61% had iron deficiency (P ≤ .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P < .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B12, and ferritin (females) compared with both adhering adolescents and the control group (all P < .04). Conclusions: Half of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies. © 2019 American Society for Bariatric Surgery
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| 4. |
- Laurenius, Anna, et al.
(författare)
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Dumping symptoms is triggered by fat as well as carbohydrates in patients operated with Roux-en-Y gastric bypass
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 13:7, s. 1159-1164
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dumping syndrome after Roux-en-Y gastric bypass (RYGB) is traditionally associated with the consumption of refined carbohydrates, but the role of dietary fat is unclear. Objectives: This study compares symptoms after consumption of a carbohydrate-rich or fat-rich beverage to determine perceived symptoms, glycemic control, and pulse rate. Methods: We assessed perceived symptoms (Sigstad's Dumping Index) and glycemic control (P-glucose and S-insulin) as well as autonomic nervous system activity (reflected by arterial pulse rate) after a standardized liquid meal test (440 kcal/300 mL carbohydrates [CARB] or fat [FAT]) in a randomized crossover blinded setting. Blood samples were drawn before and 1, 15, 30, and 60 minutes after finishing each meal and the area under the curve (AUC) was calculated. Results: Twelve patients 42 +/- 10 months after undergoing RYGB were studied. AUC differed between drinks for glucose (P = .003) and insulin (P = .005). Pulse rate increased more after CARE than after FAT (P = .01). AUC for perceived symptoms in the Sigstad's Dumping Index were similar after meals (P = .79), yet the pattern of type of symptoms differed. Conclusion: In patients with RYGB, a meal with predominant fat content resulted in as much perceived dumping symptoms as a carbohydrate-profiled meal. As expected, an increase in glucose and insulin levels were found only after carbohydrate intake and the pulse rise was more pronounced for carbohydrates than fat. Dietary counseling in patients undergoing RYGB should address dietary fat as well as traditional information about carbohydrates to avoid dumping symptoms. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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| 5. |
- Laurenius, Anna, et al.
(författare)
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Early dumping syndrome is not a complication but a desirable feature of Roux-en-Y gastric bypass surgery
- 2016
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Ingår i: Clinical Obesity. - : Wiley. - 1758-8111 .- 1758-8103. ; 6:5, s. 332-40
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Tidskriftsartikel (refereegranskat)abstract
- Early dumping syndrome after gastric bypass surgery due to rapid delivery of hyperosmolar nutrients into the bowel causing intense symptoms is often described as a complication. Twelve patients, mean age 47 years, were interviewed approximately 9 years post-operation. The interviews were audiotaped and transcribed verbatim, followed by an inductive content analysis to reveal patients' experience of the dumping syndrome. The core category 'Dumping syndrome is a positive consequence of Roux-en-Y gastric bypass surgery and a tool to control food intake' was identified based on the following four sub-categories: (i) 'The multidimensional emergence and effects of dumping syndrome', (ii) 'Dumping syndrome as something positive although unpleasant', (iii) 'Developing coping mechanisms and ingenious strategies' and (iv) 'My own fault if I expose myself to dumping syndrome'. From the patients' perspective, dumping syndrome gives control over food intake; although the symptoms were unpleasant, patients considered dumping syndrome as a positive protection against over-consumption. Hence, healthcare professionals should not present dumping syndrome as a complication but rather as an aid to control eating behaviour and excessive food intake.
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| 6. |
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| 7. |
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| 8. |
- Laurenius, Anna, et al.
(författare)
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Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115
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Forskningsöversikt (refereegranskat)abstract
- Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
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| 9. |
- Laurenius, Anna, et al.
(författare)
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Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler. : Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler.
- 2018
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Ingår i: Lakartidningen. - 1652-7518. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.
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| 10. |
- Laurenius, Anna, et al.
(författare)
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Possible relation between partial small bowel obstruction and severe postprandial reactive hypoglycemia after Roux-en-Y gastric bypass.
- 2019
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Ingår i: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - : Elsevier BV. - 1878-7533 .- 1550-7289. ; 15:6, s. 1024-1028
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Tidskriftsartikel (refereegranskat)abstract
- Although dietary treatment ameliorates symptoms in most patients with postbariatric hypoglycemia (PBH), there is a subgroup with severe symptoms that do not respond sufficiently to either diet or drugs. A clinical observation showed that those patients additionally experienced postprandial abdominal discomfort or pain.This report describes patients with severe PBH following laparoscopic Roux-en Y gastric bypass undergoing corrective surgery to alleviate partial small bowel obstruction (kink, adhesions, dysfunctional anastomosis) and the subsequent outcome regarding symptoms of PBH.Sahlgrenska University Hospital, Sweden.Retrospective analysis regarding hypoglycemic symptoms from medical records and a complementary telephone interview.Out of 80 patients treated for severe PBH at our tertiary academic surgical unit over the last 4 years, 38 underwent corrective surgery (adhesiolysis and/or a reconstructed jejuno-jejunostomy). Out of 21 patients using medications to control hypoglycemia before corrective surgery, 19 (90.5%) discontinued the medication, and 5 of 19 (26%) no longer needed to use a blood glucometer or a continuous glucose monitor. Although patients after surgical correction still could experience PBH, symptoms were less frequent and less severe. Postprandial abdominal symptoms decreased, and patients reported improved eating quality. Patient interviews revealed that 8% became entirely free of PBH symptoms after surgery and 71% experienced significant relief.We propose a possible association between severe hypoglycemic symptoms after laparoscopic Roux-en Y gastric bypass and partial small bowel obstruction. Patients with PBH not responding adequately to diet and drug treatment may benefit from assessment and intervention for partial small bowel obstruction.
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| 11. |
- Martin, Lena, et al.
(författare)
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Stark inför kirurgi – stark för livet
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Hälsosamma matvanor och god nutrition har stor betydelse för patientens autonomi, vårdbehov och rehabilitering och är grundläggande för övrig behandling. Att säkerställa att patienten har bästa möjliga nutritionsstatus inför planerad kirurgi, i det akuta efterförloppet och under sin rehabilitering har stor betydelse i omvårdnads- och läkningsprocessen. Rätt mat och näring är en viktig patientsäkerhetsfråga.Undernäring leder till sämre resultat av medicinsk och kirurgisk behandling, förlängd vårdtid och ökad risk för komplikationer, lidande och död. Säker vård avseende nutrition baseras på̊ bedömning av undernäring eller risk för undernäring, utredning av orsak samt adekvat näringsbehandling.God och säker vård är personcentrerad och evidensbaserad. Den bedrivs i team och bygger på kommunikation mellan alla inblandade. Ett strukturerat arbete med ohälsosamma matvanor och nutritionsbehandling inför kirurgi bygger på att olika professioner arbetar tillsammans med patienten i centrum. Dietisten kan erbjuda nutritionsbehandling på̊ individnivå̊.Vi hoppas att denna broschyr kan bidra till ett strukturerat nutritionsarbete inför planerad kirurgi och göra vården kring mat och näring i samband med kirurgi bättre och säkrare för alla som den berör.
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| 12. |
- Martin, Lena, et al.
(författare)
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Stark inför kirurgi – stark för livet
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Hälsosamma matvanor och god nutrition har stor betydelse för patientens autonomi, vårdbehov och rehabilitering och är grundläggande för övrig behandling. Att säkerställa att patienten har bästa möjliga nutritionsstatus inför planerad kirurgi, i det akuta efterförloppet och under sin rehabilitering har stor betydelse i omvårdnads- och läkningsprocessen. Rätt mat och näring är en viktig patientsäkerhetsfråga.Undernäring leder till sämre resultat av medicinsk och kirurgisk behandling, förlängd vårdtid och ökad risk för komplikationer, lidande och död. Säker vård avseende nutrition baseras på̊ bedömning av undernäring eller risk för undernäring, utredning av orsak samt adekvat näringsbehandling.God och säker vård är personcentrerad och evidensbaserad. Den bedrivs i team och bygger på kommunikation mellan alla inblandade. Ett strukturerat arbete med ohälsosamma matvanor och nutritionsbehandling inför kirurgi bygger på att olika professioner arbetar tillsammans med patienten i centrum. Dietisten kan erbjuda nutritionsbehandling på̊ individnivå̊.Vi hoppas att denna broschyr kan bidra till ett strukturerat nutritionsarbete inför planerad kirurgi och göra vården kring mat och näring i samband med kirurgi bättre och säkrare för alla som den berör.
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| 13. |
- Sundbom, Magnus, et al.
(författare)
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Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry.
- 2017
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Ingår i: Annals of Surgery. - Philadelphia PA, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 265:6, s. 1166-1171
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. Background: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. Methods: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m2] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases. Results: BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m2 at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%–5.9%), hypertension (29.7%–19.5%), dyslipidemia (14.0%–6.8%), and sleep apnea (9.6%–2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%–27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively. Conclusions: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation. Studies with long-term results after bariatric surgery are surprisingly rare, 1–5 especially in the light of the large number of procedures performed worldwide. In most studies there is a 1 to 2-year follow-up, 6 and at such an early point in time, it is impossible to evaluate the true effect of gastric bypass, because patients have just reached their nadir in weight. Moreover, for this group of patients, the longstanding remission of obesity-related comorbidities, for example, diabetes mellitus, hypertension, dyslipidemia, and sleep apnea, are of utmost importance. The Scandinavian Obesity Surgery Registry (SOReg) was launched in 2007 as a quality registry for the expanding number of bariatric surgeries in Sweden. 7 In 2015, SOReg contained more than 50,000 bariatric procedures (>98% national coverage), with all 43 operating centers reporting to the registry. There has been an expansion of bariatric surgery, with 3300 bariatric procedures performed in 2008, 4800 in 2009, 7800 in 2010, and 8600 in 2011. There has been a slight decrease in procedures, and currently approximately 7000 performed annually, and approximately 95% of the reported procedures have been primary laparoscopic gastric bypass. 8 Perioperative complication rates (eg, 1.2% leaks) and mortality are low (0.04%), the latter validated with the Swedish Population Register. Regular audits are performed by randomly comparing data in SOReg with patient charts at the surgical centers, demonstrating a high validity with less than 2% incorrect values. 7 Furthermore, by cross-linkage with the national Prescribed Drug Registry (PDR), a 100% follow-up of the occurrence of comorbid disease (defined as medical treatment) can be achieved. The present study reports outcome in weight and obesity-related comorbid disease in a nationwide cohort of 26,119 individuals over 5 years after primary Roux-en-Y gastric bypass (RYGB) in Sweden, using the prospective SOReg database with cross-linkage with the PDR.
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