Bariatric surgery is the most effective treatment for sustained weight reduction, and it can result in substantial improvements in the severity of type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and quality of life. However, sleeve gastrectomy, a weight loss surgery that removes two-thirds of the stomach, reduces appetite and nutrient absorption, impairing digestion and the absorption of nutrients like iron, vitamin B12, and protein-bound nutrients. This case study aims to demonstrate that patients undergoing sleeve gastrectomy require long-term and periodic monitoring of biochemical data, weight changes, and caloric and protein intake by a professional nutritionist to prevent malnutrition and nutritional deficiencies. In this case study, a 48-year-old woman was diagnosed with morbid obesity, hypertension, sleep apnea syndrome, and chronic gastritis. At initial evaluation, she was 160 cm tall and weighed 89 kg, with a body mass index of 34.8 kg/m2. At 1 postoperative year, she consumed 650 kcal and 25 g of protein per day, the percentage of excess weight loss was 141.1%, and body mass index was 21 kg/m2. Compared to preoperative levels, calcium and folic acid levels did not decrease after 1 postoperative year, but hemoglobin, ferritin, and vitamin B12 levels decreased. In conclusion, when patients experience rapid weight loss after sleeve gastrectomy, follow-up should be frequent and long. Dietary education should be conducted according to digestive symptoms, and oral nutritional supplements, including vitamins and minerals.
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As prevalence of metabolic syndrome has rapidly increased over the past decade, lifestyle changes including dietary habits are considered as a therapeutic cornerstone for metabolic syndrome, cardiovascular complications and type 2 diabetes. We evaluated the effectiveness of a telephone-delivered nutrition education to improve metabolic parameters compared with a single-visit with a dietitian in subjects with metabolic syndrome. A total of seventy-one adults who met diagnostic criteria for the metabolic syndrome were randomly assigned to either the single-visit group or the in-depth nutrition education group during a 3-month intervention study period. The in-depth telephone-delivered nutrition education group had an initial visit with a dietitian and additional two telephone counseling during the first 4 weeks of the study periods. Sixty-six subjects completed a 3-month intervention study. The trial examined participant's anthropometric changes and dietary intakes as well as changes in the metabolic syndrome factors. At the end of the trial, the in-depth nutrition education group showed significantly higher reduction in weight, body fat and abdominal circumference compared with the other group (p < 0.05). In the in-depth nutrition groups, the prevalence of metabolic syndrome was decreased to 45.5%, while 69.7% of the subjects were metabolic syndrome patients in the single-visit group (p < 0.05). These results demonstrate that the telephone-intervention counseling is a feasible mean to deliver dietary intervention in patients with metabolic syndrome.
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