Diabetes & its Complications

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1 Research Article Research Article Diaetes & its Comlications Comarıson of Weıght and Body Comosıtıon Change in Person Usıng and Non-Usıng Proteın Powder İn the Fırst 6 Months Perıod after Barrıer Surgery Nazlı Batar * and Merve Üzel 1 Lecturer, T.C İstanul Bilim University, Vocational School of Health, Deartment of Nutrition and Dietetic, İstanul, Turkey. 2 Dietitian, Trakya, Turkey. * Corresondence: Nazlı Batar, Lecturer, T.C İstanul Bilim University, Vocational School of Health, Deartment of Nutrition and Dietetic, Şişli, İstanul, Turkey, nazacarli@gmail.com. Received: 12 Feruary 2018; Acceted: 28 Feruary 2018 Citation: Batar N, Üzel M. Comarıson of Weıght and Body Comosıtıon Change in Person Usıng and Non-Usıng Proteın Powder İn the Fırst 6 Months Perıod after Barrıer Surgery. Diaetes Comlications. 2018; 2(1): 1-7. ABSTRACT Ojective of Study: This study aims the comarison of weight and ody comosition changes in eole who use and do not use rotein in the first six months eriod after the ariatric surgery. Material and Method: This study was carried out on 144 atients who underwent ariatric surgery at a rivate foundation university etween and and were followed u efore and after the oeration. The atients were searated into two grous those who use rotein dust and who do not.the memer quantity of two grous are equal and 72. Tanita Body Comosition Analyzer TBF-300 was used to analyze the atients ody. Facts: The ages of the atients ranged from 18 to 68 years with an average of ± years, 63.3% using rotein dust, and 36.7% not using rotein dust although recommended. As a result of the study, the differences etween the fat ercentage ratios of the cases in oth grous were statistically significant at ostoerative 6th month controls (<0.05). When the weight ratios of the cases were examined, no statistically significant difference was found etween the two grous. When the muscle ratios of oth grous are evaluated; The difference etween the ody muscle ratios of the ost o 1st month controls was statistically significant ( <0.05) and the difference etween the ody muscle ratios of the two grous at the ost o 6th month controls was statistically highly significant (P<0.01). Results: As a result, it has een oserved that the ody fat ercentage decreases more than the ody fat ercentage according to the second grou, which does not receive rotein owder sulementation, in grou 1 cases, which regularly take rotein owder sulementation, and that ody fat weight is less well reserved. Keywords Bariatric surgery, Body comosition, Oesity, Protein sulement, Sleeve gastrectomy. Introduction Oesity are often descried as anormal or excessive fat accumulation that can e detrimental to health.the revalence of overweight and oesity is increasing indeendently of the economic situation in many countries. There are 1.9 illion overweight adults in the world; of which aroximately 600 million are oese [1]. According to the World Health Organization (WHO) reorts, oesity affects 1.1 illion adults worldwide with a clinical 30 kg\m 2 ody mass index (BMI). It can cause many health rolems such as hyertension, stroke and ischemic one disease. Studies have shown that survival from vascular comlications of individuals with a BMI of 40 to 45 kg/m 2 is reduced y 8 to 10 years, comared with individuals with a normal BMI [2]. Oesity is an indeendent risk factor for all-cause mortality, mostly due to cardiovascular disease, in the general oulation. According Volume 2 Issue 1 1 of 7

2 to the World Health Organization, the revalence of oesity has increased over 100% gloally since 1980, and the numer of oese individuals in 2014 is estimated at 600 million. Therefore, oesity is ecoming a gloal ulic health rolem [3]. One of the main causes of oesity in adults is overweight in childhood. Over weighted children grow u and ecome over weighted adults. The treatment of ediatric oesity is ased on the alance of the calories taken and the calories consumed. Lifestyle changes, family intervention and suort increase the success rate. In this treatment, 3 asic elements; etter eating haits, more hysical activity and sedantering away from life. The frustrating result of all of this is encouraging individuals to resort to ariatric rocedures. The raid increase in the revalence of morid oesity in the oese oulation and the risk of mortality have led to an increase in annual ariatric surgical rocedures [4]. Finding and increasing the variety of surgical rocedures aimed at treating oesity is a source of hoe for many individuals struggling with weight loss.in many cases these rocedures offer life-changing solutions [5]. Treatment Methods of Oesity Medical Nutrition Theray The main urose of diet lanning is to rovide adequate and alanced nutrition according to the age, sex, hysical activity level, and hysiological condition and nutrition haits of the individual [5]. Exercise Theray Exercise has an imortant role in the treatment of oesity and lays a major role as a comlement to dietary theray. Exercise also increases lean ody mass and hels maintain long-term weight loss [7]. Medication Several drugs have een used in the treatment of oesity to reduce the level of fasting. Commonly used drugs are amhetamines and their derivatives that directly affect the starvation centers in the rain. Another grou of drugs works y changing the liid asortion in the intestines [8]. Surgery Bariatric surgery has evolved when atients who undergo artial gastrectomy for etic ulcer disease lose weight or find it difficult to gain weight. Considering this concet, early interventions in weight loss surgery include jejunoileal and jejunocolic yass rocedur [9]. Indications of Bariatric Surgery Successful weight loss is aimed at the asic rincile of ariatric surgeon. Surgical treatment criteria were estalished in 1991 y the Consulate anel of the National Institutes of Health.The secific queriori for ariatric surgery acceted y the National Institutes of Health is stated to e alicale to atients with BMI Kg/m 2 > 40 and atients with BMI, Kg/m ut comoridity. Indications for ariatric / metaolic surgery are develoing raidly, taking into account the severity of oesity as well as the resence or asence of comorid conditions according to the BMI. Comorid conditions are exected to imrove or remission in the event of effective and ermanent weight loss. Comorid conditions associated with oesity; Tye 2 diaetes, dysliidemia, lung diseases, cardiovascular system diseases, cancer, infertility [10]. A multidiscilinary team, including medical doctors, dietitians, sychologists exerienced in this field, and a surgeon exerienced with ariatric rocedures are very imortant for otimal outcome. It is recommended that follow-u e done to suort the necessary changes in long-term ehavior in order to otimize the results. The target weight loss after surgery is almost reached in the first 1-2 years. Significant imrovement in the medical comlications of oesity can occur in all atients with a successful weight loss. For these reasons, ariatric surgery has ecome an imortant tool in the treatment of medically comlicated oesity [11]. The successful treatment of oesity highly deends on motivation of atients.however, surgery should have to e taken into consideration after atients have acceted the weight rolem and have roved themselves ale to comly with the weight loss rogram. Finally, ecause treatment of oesity requires lifelong adjustment to lifestyle changes in the form of increased hysical activity and reduced calorie intake, true atient motivation is needed for sustained ositive outcomes. A weight loss of only 5 to 20 kg may e associated with a reduction in systemic lood ressure and lasma liid concentrations and etter control of diaetes. Due to the long-term enefits of this surgery for clinically severe oese atients, ariatric surgery is more frequently erformed than 10 years ago [12]. There is evidence that myocardial infarction, stroke, cardiovascular events, and mortality are reduced y aout half comared to nonsurgical controls such as diet theray and medical treatment during the 2-15 year follow-u eriod [13]. Pulmonary emoli (30-40%), cardiac events (25%) and anastomotic leaks follow ariatric oerations [14]. Duming syndrome, wound infections, strictures and stomal ulcerations are the most common comlications [15]. Material and Method This study consisted of atients who had undergone sleeve gastrectomy at a foundation university etween and and who continued to follow nutrition efore and after surgery. Among these dates, 144 ersons were included in the study ecause the others of 453 oerated ersons did not continue to follow the nutrition.while 72 atients reorted using rotein sulement, 72 atients reorted that they did not use roteinsulement on their own initiative desite their recommendation, although it is indicated that rotein owder consumtion was articularly recommended during the first ostoerative month. The records are noted in this way y the resonsile dietitian. Body weight and heights were measured as lightweight clothes and shoes. Volume 2 Issue 1 2 of 7

3 Tanita Body Comosition Analyzer (model TBF-300; Tanita Cor., Tokyo, Jaan) was used to measure the ody mass of the articiants with a sensitivity of 0.1 kilograms (kg). Particiants heights were transformed in meters (m) after measuring in 0.1 centimeters (cm). BMI was calculated using the following formula: BMI = ody weight (kg)/[height (m)] 2. Tanita Body Comosition Analyzer (model TBF-300; Tanita Cor., Tokyo, Jaan) was used to determine the ody fat ercentage and amount of articiants. The accuracy of the Tanita TBF-300 is considered to e high to measure the ody fat amount [16]. The urose of this study was to evaluate the effect of sleeve gastrectomy surgery etween and and the comarison of weight, fat ratio and muscle mass change during the first 6 months of atients who use and not use rotein sulements. In addition to the comlementary statistical methods (mean, standard deviation, ratio), one-way Anova test was used in the two-grou comarison of the arameters that showed normal distriution and the Tukey HDS test was used in determining the grou causing the difference. For susequent measurements of the arameters, Variance Analysis in reeated measures and aired samle t test in inary comarisons were used.significance was assessed at <0.01 and <0.05 levels. Results This study was conducted etween and and who continued to follow nutrition efore and after surgery. 144 male and female atients were followed u efore and after the oeration. The ages of the cases ranged from 18 to 68 years with a mean of ± years (Tale 1). Min-Max Mean ± SD Age (year) ± n% # of atients used rotein (Grou 1) # of atients not used rotein (Grou 2) Total Tale 1: Studies on the distriution of atients using and not using roteins. Tale 2: Analyzes of Body Fat Changes in Patients using and not using rotein. a Oneway Anova Test Variance Analysis in reeated measures * <0.05 ** < 0.01 c Adjustment for multile comarisons;bonferroni The mean ody fat ercentages in the reo eriod were ± 5.60 in the first grou and ± 5.34 kg in the second grou (Tale 2). There was significant difference in the ody fat ercentage measurements of the controls of grou 1 cases (<0.01).According to the ilateral comarisons made; The decrease in fat ercentages at ostoerative first month was not statistically significant (>0.05), whereas the decrease in fat ercentage at ostoerative 6th month was statistically significant (<0.01). Statistically significant differences were found in ody fat ercentage measurements of grou 2 controls comared to the reoerative eriod measurements (<0.01). There was no statistically significant decrease in the ercentages of fat in the first ostoerative month (>0.05) comared to the reo ody fat ercentages of the cases (>0.05). On the other hand, the decrease in the ercentage of fat in the ostoerative 6th month was statistically significant (<0.01). The difference etween the fat ercentages in the reoerative eriod was significant ( = , <0.05) when we comared the first grou cases called rotein owder users and the second grou cases called nonuse users. There was no significant difference etween the ody fat ercenteges of two grous in the ostoerative 1 month (=0.06; <0.05). Significant differences were found etween the two grous in the ody fat ercentages reevaluated at osto 6 month (=0.0117, <0.05). We oserved more loss of fat in gru 1 cases than grou 2 atients who did not use rotein owder. As seen in Tale 3, 63.3% of the cases used rotein owder, while 36.7% did not use rotein owder. GROUP 1 GROUP 2 Body Fat Ratio (%) Mean ± SD Mean ± SD a Preo ± ± 5.34 * st Month Check ± ± st Month Check ± ± 6.17 * **0.0 **0.0 Bilateral Comarison c c Preo * 1st Month Check Preo * 6st Month Check **3.914e-14 **2.277e-13 Figure 1: Change in fat ercentage (%) of cases using and not using rotein. The re-oerative ody fat ercentages and ost-oerative ody fat ercentages of our cases are similar to those in Figure 1. Volume 2 Issue 1 3 of 7

4 GROUP 1 GROUP 2 Body Fat Ratio (%) Mean ± SD Mean ± SD a Preo ± ± st Month Check ± ± st Month Check ± ± **0.0 **0.0 Bilateral Comarison c c Preo * 1st Month Check ** ** Preo * 6st Month Check **1.2529e-18 **1.9433e-19 Tale 3: Analyzes of Body Weight Changes in Patients using and not using rotein. a Oneway Anova Test Variance Analysis in reeated measures *<0.05 **<0.01 c Adjustment for multile comarisons; Bonferroni The mean ody weight in the reo eriod was ± kg in the first grou and ± kg in the second grou (Tale 3). Statistically significant differences (<0.01) were found in the measurements of ody weight changes in first grou during controls with restect to the results taken in reoerative eriod. The decrease in the ody weights at the ostoerative 1st month and 6th month according to the reo ody weights of the cases in the ilateral comarisons were found statistically highly significant ( = , = e-18, <0.01). GROUP 1 GROUP 2 Body Fat Ratio (%) Mean ± SD Mean ± SD a Preo ± ± st Month Check ± ± * st Month Check ± ± 9.05 ** **0.0 **0.0 Bilateral Comarison c c Preo * 1st Month Check * Preo * 6st Month Check ** **1.077e-7 Tale 4: Examination of Body Muscle Changes in Patients Using and not Using Protein. a Oneway Anova Test Variance Analysis in reeated measures *<0.05 **<0.01 c Adjustment for multile comarisons;bonferroni The mean ody muscle weight in the reo eriod was ± Kg in the first grou and ± Kg in the second grou (Tale 4). There was significant difference (<0.01) etween ody muscle weight measured in reo eriod and ost-oerational eriod of atients in first grou. According to the comarison results, there was no statistically significant decrease in ody muscle weight for first month ost-oerational eriod ( = 0.09; <0.05). The decrease in fat ercentage at the ostoerative 6th month was highly statistically significant ( = ; <0.01). Statistically significant differences were found (<0.01) in the measurements of ody weight changes in grou 2 controls comaring to reoerative eriod.the decrease in the ody weights at ostoerative 1st and 6th months comaring to the reoerative measurements of ody weights of the atients was found statistically significant ( = , = e-19, <0.01). When we comared the first grou atients using rotein owder and the second grou, the difference etween the ody weights at reo, osto 1 month and osto 6 months was not significant. Figure 3: Muscle ratio changes of the atiens using rotein sulement and not using rotein sulement. Statistically significant differences were found in the measurements of ody muscle changes in second grou comarisons with resect to reoerative eriod measurements ( <0.01). Statistical significance was found etween the reo ody muscle weights of the atients and the muscle weight measurements at the 1st ostoerative month ( = , <0.05). Also, the decrease in the ody muscle weights at the 6th month was statistically highly significant ( = e-7; & lt; 0.01). Figure 2: Weight change of atients using and not using rotein. Pre-oerative and ost-oerative weight ratios of our cases are shown in Figure 2. According to the comarison results of two grous, there were statistically significant differences in ostoerative first month ody muscle weight measurements and the muscle loss measured and calculated at ostoerative sixth month is highly statistically Volume 2 Issue 1 4 of 7

5 significant. Muscle loss in grou 2 atients that do not use rotein dust is greater than in grou 1 atients. The reoerative muscle rates of our cases and the muscle rates of all the ost-oerative follow-us are similar to those of Figure 3. Discussion In this oservational study on the atients receiving RYGB and SG is aimed at assessing the association etween daily rotein intake and lean ody mass loss as a ercentage of total weight loss during the 4th and 12th months following surgery. Dietary advice and daily rotein intake were assessed at the 2nd, 6th weeks, 4th, 8th and 12th months efore the oeration. Although ariatric surgery is the most imortant strategy for achieving and sustaining significant weight loss in morid oese individuals, there is concern that ariatric surgery may cause more lean ody mass loss than other weight loss interventions. Patients on a hyocaloric and rotein-rich diet were classified ased on the success of their two-day rotein intake goal.the study showed that following RYGB and SG, more rotein intake was associated with etter fat-free ody mass loss rotection. Desite the fact that articiants in the study did not achieve the amount of rotein utake today, the results suorts the roosed rotein intake goal of at least 60 g/d or 1,1 g/kg IBW/day, which is significantly related to the etter rotection of lean ody mass loss [17]. Findings that we have in our work also suort the studies done in the literature. Comaring the two grous so called using and not using rotein, the differences etween ody muscle loss in ostoerative first month is statistically significant (=0.026; <0.05). In addition, the ody muscle loss comarison in ostoerative sixth month is highly statistically significant (=0.0005; <0.01). Muscle loss in grou 2 atients that do not use rotein dust is greater than in grou 1 atients. According to the researches; no changes in alumin or realumin levels were found after 6 and 12 months of ariatric surgery regardless of rotein sulement or tye of surgery. In most studies, rotein intake was found to e less than 60 g/day. In addition, there was significant lean ody mass loss after RYGB and SG. No association etween rotein intake and serum rotein levels was found out [18]. In a study involving the ariatric surgery-exosed rotein grou and the control grou, ody weight decreased significantly in oth grous, ut ody fat mass loss was oserved higher in the rotein grou than in the control grou. This study demonstrates that after 6 months of ariatric surgery, rotein sulement imroves ody comosition y increasing ody fat mass loss and reducing lean ody mass loss [19]. When we comared the first grou cases that we named rotein dust users with the second grou cases that we named as nonusers, there was no significant difference etween the measured fat ratios in ostoerative first month of two grous (=0.06, <0.05). Significant differences were found etween the two grous in the ody fat ercentages reevaluated at osto 6 month (=0.0117, <0.05). We oserved more loss of fat ercentages than grou 2 atients who did not use rotein dust in grou 1 cases. After all ariatric rocedures, lifelong vitamin and mineral sulementation is recommended. Evidence of vitamin and mineral deficiencies can take a long time, so iochemical tests will e helful in detecting nutritional status [20]. GBP and SG have similar effects in terms of risk of micronutrient and rotein failure in the first year after ariatric surgery due to energy and food restrictions [21]. Micronutrients recommended for routine ost-ariatric surgery are selected according to AACE/TOS/ ASMBS Mineral multivitamins Vertikalandedgastrolasti (VBG), Roux-en-Y gastric yass (RYGB) methods are recommended to suort 1-2 talets of renatal minerals daily after ariatric surgery [22]. In studies comaring early endocrine and metaolic changes in oese atients in grade III, the reduction of stomach wall and volume restriction, remature satiety, revents the release of oroxygenic hormones y yassing the excreted stomach. The resence of undigested food in the terminal tract triggers the incretin effect. These mechanisms exlain early recovery in some asects of the metaolic syndrome indeendently of significant weight loss [23]. In a clinical trial with randomized 60 atients, the effects of SG and BG in first degree oese atients are comared. The atients having SG have greater weight loss in sixth and tvelveth months. In a retrosective analysis of a cohort of 71 GB of 38 GB y Bayham et al., Both grous were studied for u to 60 days ostoeratively. During this eriod, 79 ercent of atients with GB and 83 ercent of atients with SG did not take medication for diaetes. In the rosective cohort extending to ostoerative 90th day, it was oserved that the numer of atients with the ossiility of having diaetes in the GB grou was higher than the SG grou [24]. In the same cohort, Schauer and colleagues reorted imrovement in three grous of glycemic control at the end of 12 months, with an average HA1c of 7.5 in the drug grou, 6.4 in the GB grou and 6.6 in the SG grou. Significant differences were found in the amount of decrease in HA1c etween the two grous for 90 days in the study [25]. Random insulin increased after VSG, ut random lood sugar decreased. Lactate, NADH, NADPH, glucose and AMP/ATP ratio were found to increase after VSG, while gluconogenic enzymes and yruvate and malate concentrations were found to decrease. Thyroid hormones, triiodothyronine and free thyroxine have decreased after VSG. In this study, VSG is roved to suress heatic glucose roduction [26]. Volume 2 Issue 1 5 of 7

6 In a study conducted y SG and RYGB to evaluate anthroometric and iochemical arameters, including changes in glucose levels, liid rofile, and liver function, no significant difference in glucose levels was oserved etween the two methods. The most significant differences were recorded for triglyceride levels. Triglyceride values decreased after all the cholesterol fractions after RGB, ut showed an increase in the first months after SG treatment. However, ecause of the invasive character of RYGB, lifetime limited asortion of nutrients; SG rocedure should e considered as the first otion [27]. Conclusions and Recommendations As a result of analyzes made, the differences etween the fat ercentage ratios of the atients in oth grous were statistically significant at ost o 6th month controls. When the weight ratios of the cases were examined, no statistically significant difference was found etween the two grous.when the muscle ratios of oth grous are evaluated; ost-o 1st month controls had statistically significant results, while ost-o 6th month controls revealed highly statistically significant changes in ody muscle rates of the two grous. As a result, we oserve that while ody fat ercentage is more decreased in grou 1 atients, that regularly taking rotein sulement, comared to grou 2, we oserved that the lean ody mass is etter reserved. In this study to investigate the effect of rotein sulementation on ody comosition in atients undergoing ariatric surgery, rotein sulementation should e erformed on each atient and ody comosition analysis should e erformed with regular checks to ensure that weight loss is achieved y fat mass instead of fat-free mass. Quality roteins should e a to choice in the attern of hyocaloric and rotein rich diets. The creation of this consciousness in ariatric surgery atients will succeed us. References 1. Akindele MO, Phillis JS, Igumor EU. The relationshi etween ody fat ercentage and ody mass index in overweight and oese individuals in an uran African setting. J Am Heart Assoc. 2016; 7: El husseny MWA, Mamdouh M, Shaan S, et al. Adiokines Potential Theraeutic Targets for Vascular Dysfunction in Tye II Diaetes Mellitus and Oesity. J Diyaet Res. 2017; Brant LCC, Wang N, Ojeda FM, et al. Relations of Metaolically Healthy and Unhealthy Oesity to Digital Vascular Function in Three Community-Based Cohorts: A Meta-Analysis. J Am Heart Assoc. 2017; 6: Eckmann DM. Anesthesia for Bariatric Surgery. Miller's Anesthesia. Ed: RD Miller. San Francisco, Elsevier. 2015; Greenerg MJ. Preoerative Evaluation. Pfenninger and Fowler's Procedures for Primary Care. Ed: K Dimock ve J Milla. UnitedStates of America, Elsevier. 2010; Al G. Determination of the Effect of Oesity Theray on Weight Loss in a Secial Physical Theray Center. BÜ Health Sciences Institute Deartment of Nutrition and Dietetics, Master Thesis, 2014; Ankara (Consultant: Prof. Dr. Muhittin TAYFUR). 7. Keskin L. How Effective is Oesity Treatment for Correcting Oxidative Stress? Difference Between Medicines?. İÜ Medical School Deartment of Internal Medicine Deartment of Endocrinology and Metaolism, Minor Siecialization Thesis, 2009; Malatya (Consultant: Doç. Dr. İrahim ŞAHİN). 8. Hall JE. Dietary Balances Regulation of Feeding; Oesity and Starvation Vitamins and Minerals. Guyton and Hall Textook of Medical Physiology. Ed: Philadelhia, Elsevier. 2016; Fink J. Bariatric surgery Preoerative Evaluation and ostoerative care. Medical management of the surgical atient. Medical Management of the Surgical Patient. Ed: D Martin and J Ingram. Pennsylvania, Elsevier. 2008; Wolfe BM, Kvach E, Eckel RH. Treatment of Oesity Weight Loss and Bariatric Surgery. Circulation Research. 2016; 11: Jensen MD. Oesity. Goldman- CecilMedicine. Ed: L. Goldman ve A Schafer, Philadelhia, Elsevier. 2016; Hines RL, Marschall K. Nutritional Diseases: Oesity and Malnutrition. Stoelting's Anesthesia and Co-Existing Disease. Philadelhia, Elsevier. 2012; Elia M, Lanham SA. Nutrition. Kumar and Clark's Clinical Medicine. Ed: Feather A. London, Elsevier. 2017; Cone RD, Elmquist JK. Neuroendocrine Control of Energy Stores. Williams Textook of Endocrinology. Ed: S. Melmed, KS. Polonsky, PR. Larsen, H. Kronenerg. Philadelhia, Elsevier. 2016; Poirier RF. Comlications of Bariatric Surgery. Emergency Medicine. Ed: JG. Adams ve ED. Barton. Philadelhia, Elsevier, 2013; Ballesteros-Pomar MD, Calleja-Fernandez A, Diez- Rodriguez R, et al. Comarison of different ody comosition measurements in severely oese atients in the clinical setting. Nutr Hos. 2012; 27: Moizé V, Andreu A, Rodríguez AL, et al. Protein intake and lean tissue mass retention following ariatric surgery. Clinical Nutrition. 2013; 32: Ito KM, Gonçalves VSS, Faria SLCM, et al. Effect of Protein Intake on the Protein Status and Lean Mass of Post-Bariatric Surgery Patients a Systematic Review. Oesity Surgery. Ed: KM. Ito. New York, sringer. 2016; Schollenerger AE, Karschin J, Meile T, et al. Imact of rotein sulementation after ariatric surgery A randomized controlled doule-lind ilot study. Nutrition. 2016; 32: Shannon C, Gervasoni A, Williams T. The ariatric surgery atient nutrition considerations. AustFam Physician. 2013; 42: Verger EO, Aron-Wisnewsky J, Dao MC, et al. Micronutrient and Protein Deficiencies After Gastric Byass and Sleeve Volume 2 Issue 1 6 of 7

7 Gastrectomy: a 1-year Follow-u. Oesity Surgery. 2016; 26: Schweitzer DH ve Posthuma EF. Prevention of Vitamin and Mineral Deficiencies after Bariatric Surgery: Evidence and Algorithms. OBES SURG. 2008; 11: de Barros F, Setúal S, Martinho J. et al. Early Endocrine and Metaolic Changes After Bariatric Surgery in Grade III Moridly Oese Patients: A Randomized Clinical Trial Comaring Sleeve Gastrectomy and Gastric Byass. Metaolic Syndrome and Related Disorders. 2015; 13: Lee WJ, Ser KH, Chong K, et al. Laaroscoic sleeve gastrectomy for diaetes treatment in nonmoridly oese atients: Efficacy and change of insulin secretion. Surgery. 2010; 147: Schauer PR, Kashya SR, Wolski K, et al. Bariatric surgery versus intensive medical theray in oese atients with diaetes. N Engl J Med. 2012; 366: Lho Y, le Roux CW, Park HS, et al. Changes in Glucose Metaolism in Vertical Sleeve Gastrectomy. Oesity Surgerg. 2015; 25: Szczuko M, Komorniak N, Hoffmann M, et al. Body Weight Reduction and Biochemical Parameters of the Patients After RYGB and SG Bariatric Procedures in 12-Month Oservation. Oesity Surgery, Poland, Sringer. 2017; Batar N & Üzel M. This article is distriuted under the terms of the Creative Commons Attriution 4.0 International License Volume 2 Issue 1 7 of 7