Show me the evidence to guide nutrition practice: Scoping review of macronutrient dietary treatments after metabolic and bariatric surgery.

Julie M Parrott, Sue Benson-Davies, Mary O'Kane, J Scott Parrott, Silvia Leite Faria, Shiri Sherf-Dagan, Tair Ben-Porat, Violeta Moizé Arcone

Journal: Obesity reviews : an official journal of the International Association for the Study of Obesity 2024;25(12):e13831

PMID: 39262138

Full Text on Ovid Technologies, Inc. View on PubMed

Abstract

BACKGROUND

Clinical practice recommendations for macronutrient intake in Metabolic and Bariatric Surgery (MBS) are insufficiently grounded in the research, possibly due to a paucity of research in key areas necessary to support macronutrient recommendations. An initial scoping review, prior to any systematic review, was determined to be vital.

OBJECTIVES

To identify topical areas in macronutrients and MBS with a sufficient evidence base to guide nutrition recommendations.

METHODS

PubMed, Cochrane, Ovid Medline, and Embase were initially searched in January 2019 (updated November 1, 2023) with terms encompassing current bariatric surgeries and macronutrients. Out of 757 records identified, 98 were included. A template was created. Five types of outcomes were identified for extraction: dietary intake, anthropometrics, adverse symptoms, health, and metabolic outcomes. All stages of screening and extraction were conducted independently by at least two authors and disagreements were resolved via team discussion. Macronutrient-related dietary treatments were classified as either innovative or standard of care. Descriptions of dietary arms were extracted in detail for a qualitatively generated typology of dietary or nutritional treatments. Heatmaps (treatments by outcomes) were produced to identify promising topics for further systematic analyses.

RESULTS

We identified protein supplementation and "food-focused" (e.g., portion-controlled meals, particular foods in the diet, etc.) topical areas in MBS nutrition care with potentially sufficient evidence to create specific MBS Macronutrients guidelines and identified topical areas with little research.

CONCLUSIONS

Clinical practice regarding macronutrient intake remains guided by consensus and indirect evidence. We detail ways that leadership at the profession level may remedy this.

Address: Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.; Metabolic and Bariatric Surgery Program, Temple University Hospital, Philadelphia, Pennsylvania, USA.; Department of Surgery, Sanford School of Medicine, University of South Dakota. Sioux Falls, South Dakota, USA.; Dietetic Department, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, West Yorkshire, UK.; Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel.; Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.; Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM) -, QC, Canada.; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada.; Univeristy of Obesity, Hospital Clínic Barcelona, Spain.; Institut D'investigacions Biomèdiques August Pi I Sunyer (Idibaps), Barcelona, Spain.; Researcher at the University of Brasilia, Brasilia, Brazil.; Gastrocirurgia de Brasilia, Private Practice, Brasilia, Brazil.; Director, Rutgers School of Health Professions Methodology and Statistics Support Team, USA.; Professor, Department of Interdisciplinary Studies, Rutgers, School of Health Professions, Piscataway, NJ, USA.

DOI: 10.1111/obr.13831

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MeSH Terms: Humans, Bariatric Surgery, Nutrients, Obesity