Obesity Surgery

, Volume 29, Issue 2, pp 406–413 | Cite as

Changes in Body Composition, Dietary Intake, and Substrate Oxidation in Patients Underwent Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: a Comparative Prospective Study

  • Mahdieh Golzarand
  • Karamollah ToolabiEmail author
  • Kurosh DjafarianEmail author
Original Contributions



Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most popular procedures to treat morbid obesity among bariatric surgeries. However, only few studies have compared the changes in body composition, dietary intake, and substrate oxidation after LRYGB and LSG. Therefore, the present study was conducted to compare the changes in body composition, dietary intake, and substrate oxidation 6 months postoperatively in obese patients who underwent LRYGB and LSG.

Materials and Methods

In this prospective study, a total of 43 adult obese patients participated (LRYGB = 22 and LSG = 21). Their body composition was measured by bioelectric impedance analysis. Dietary intake was assessed using 3-day food record. Substrate oxidation was measured by indirect calorimetry. All participants were followed up for 6 months.


The percentage of weight loss was 22.8 ± 4.5 and 23.3 ± 5.7% in LRYGB and LSG, respectively. Fat mass (FM), fat-free mass (FFM), and percentage of fat mass (PFM) significantly reduced in LRYGB and LSG, while the percentage of fat-free mass (PFFM) significantly increased in both surgeries. Dietary energy intake significantly reduced by 63.5 ± 30.6% in LRYGB and 66.7 ± 20.1% in LSG. Dietary intake of protein, carbohydrate, fat, and fiber significantly decreased in each group. The percentage of energy from protein, carbohydrate, and fat did not change in each group. Protein oxidation and carbohydrate oxidation significantly reduced in both procedures postoperatively. Changes in body composition, dietary intake, and substrate oxidation from baseline were equal in LRYGB and LSG.


Therefore, LRYGB and LSG have similar effect on total and regional FM and FFM, dietary macronutrients intake, and substrate oxidation.


Gastric bypass Sleeve gastrectomy Body composition Dietary intake Bariatric surgery 


Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mitchell NS, Catenacci VA, Wyatt HR, et al. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–32.Google Scholar
  2. 2.
    Bray GA, Clearfield MB, Fintel DJ, et al. Overweight and obesity: the pathogenesis of cardiometabolic risk. Clin Cornerstone. 2009;9(4):30–40. discussion 1-2Google Scholar
  3. 3.
    Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96.Google Scholar
  4. 4.
    Friedrich AE, Damms-Machado A, Meile T, et al. Laparoscopic sleeve gastrectomy compared to a multidisciplinary weight loss program for obesity--effects on body composition and protein status. Obes Surg. 2013;23(12):1957–65.Google Scholar
  5. 5.
    Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11):4331–45.Google Scholar
  6. 6.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  7. 7.
    Crisp AH, Verlengia R, Ravelli MN, Junior IR, de Oliveira MRM. Changes in physical activities and body composition after Roux-Y gastric bypass surgery. Obes Surg. 2017.Google Scholar
  8. 8.
    Campanha-Versiani L, Pereira DAG, Ribeiro-Samora GA, et al. The effect of a muscle weight-bearing and aerobic exercise program on the body composition, muscular strength, biochemical markers, and bone mass of obese patients who have undergone gastric bypass surgery. Obes Surg. 2017;27(8):2129–37.Google Scholar
  9. 9.
    Adamczyk P, Buzga M, Holeczy P, et al. Bone mineral density and body composition after laparoscopic sleeve gastrectomy in men: a short-term longitudinal study. Int J Surg. 2015;23(Pt A):101–7.Google Scholar
  10. 10.
    Carey DG, Pliego GJ, Raymond RL, et al. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate. Obes Surg. 2006;16(4):469–77.Google Scholar
  11. 11.
    Moehlecke M, Andriatta Blume C, Rheinheimer J, et al. Early reduction of resting energy expenditure and successful weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2017;13(2):204–9.Google Scholar
  12. 12.
    Tamboli RA, Hossain HA, Marks PA, et al. Body composition and energy metabolism following Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2010;18(9):1718–24.Google Scholar
  13. 13.
    Bettini S, Bordigato E, Fabris R, Serra R, Dal Pra C, Belligoli A, et al. Modifications of resting energy expenditure after sleeve gastrectomy. Obes Surg 2018.Google Scholar
  14. 14.
    Belfiore A, Cataldi M, Minichini L, et al. Short-term changes in body composition and response to micronutrient supplementation after laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(12):2344–51.Google Scholar
  15. 15.
    Iannelli A, Anty R, Schneck AS, et al. Evolution of low-grade systemic inflammation, insulin resistance, anthropometrics, resting energy expenditure and metabolic syndrome after bariatric surgery: a comparative study between gastric bypass and sleeve gastrectomy. J Visc Surg. 2013;150(4):269–75.Google Scholar
  16. 16.
    Otto M, Elrefai M, Krammer J, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass lead to comparable changes in body composition after adjustment for initial body mass index. Obes Surg. 2016;26(3):479–85.Google Scholar
  17. 17.
    Schneider J, Peterli R, Gass M, et al. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass lead to equal changes in body composition and energy metabolism 17 months postoperatively: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(3):563–70.Google Scholar
  18. 18.
    Schiavo L, Scalera G, Pilone V, et al. A comparative study examining the impact of a protein-enriched vs normal protein postoperative diet on body composition and resting metabolic rate in obese patients after sleeve gastrectomy. Obes Surg. 2017;27(4):881–8.Google Scholar
  19. 19.
    Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr. 2005;82(1):49–52.Google Scholar
  20. 20.
    Vassilev G, Hasenberg T, Krammer J, et al. The phase angle of the bioelectrical impedance analysis as predictor of post-bariatric weight loss outcome. Obes Surg. 2017;27(3):665–9.Google Scholar
  21. 21.
    Buzga M, Zavadilova V, Holeczy P, et al. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. 2014;9(4):554–61.Google Scholar
  22. 22.
    Freeman RA, Overs SE, Zarshenas N, et al. Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Res Clin Pract. 2014;8(2):e115–200.Google Scholar
  23. 23.
    Olbers T, Bjorkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006;244(5):715–22.Google Scholar
  24. 24.
    Johnson LK, Andersen LF, Hofso D, et al. Dietary changes in obese patients undergoing gastric bypass or lifestyle intervention: a clinical trial. Br J Nutr. 2013;110(1):127–34.Google Scholar
  25. 25.
    Mercachita T, Santos Z, Limao J, et al. Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of >/= 1 year. Obes Surg. 2014;24(1):102–8.Google Scholar
  26. 26.
    Chou JJ, Lee WJ, Almalki O, et al. Dietary intake and weight changes 5 years after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(12):3240–6.Google Scholar
  27. 27.
    Gjessing HR, Nielsen HJ, Mellgren G, et al. Energy intake, nutritional status and weight reduction in patients one year after laparoscopic sleeve gastrectomy. Springerplus. 2013;2:352.Google Scholar
  28. 28.
    El Labban S, Safadi B, Olabi A. The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: a cross-sectional pilot study. Obes Surg. 2015;25(12):2393–9.Google Scholar
  29. 29.
    Moize V, Andreu A, Flores L, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.Google Scholar
  30. 30.
    Craig CL, Marshall AL, Sjorstrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95.Google Scholar
  31. 31.
    van de Laar A, de Caluwe L, Dillemans B. Relative outcome measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obes Surg. 2011;21(6):763–7.Google Scholar
  32. 32.
    Carrasco F, Papapietro K, Csendes A, et al. Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg. 2007;17(5):608–16.Google Scholar
  33. 33.
    Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring). 2014;22(12):2563–9.Google Scholar
  34. 34.
    Rabl C, Rao MN, Schwarz JM, et al. Thermogenic changes after gastric bypass, adjustable gastric banding or diet alone. Surgery. 2014;156(4):806–12.Google Scholar
  35. 35.
    Norman K, Stobaus N, Pirlich M, et al. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31(6):854–61.Google Scholar
  36. 36.
    Kirchengast S. Gender differences in body composition from childhood to old age: an evolutionary point of view. J Life Sci. 2010;2(1):1–10.Google Scholar
  37. 37.
    Aldosky HYY, Yildiz A, Hussein HA. Regional body fat distribution assessment by bioelectrical impedance analysis and its correlation with anthropometric indices. Phys Med. 2018;5:15–9.Google Scholar
  38. 38.
    Shuster A, Patlas M, Pinthus JH, et al. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85(1009):1–10.Google Scholar
  39. 39.
    Gesquiere I, Foulon V, Augustijns P, et al. Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients. Clin Nutr. 2017;36(4):1175–81.Google Scholar
  40. 40.
    Miller GD, Norris A, Fernandez A. Changes in nutrients and food groups intake following laparoscopic Roux-en-Y gastric bypass (RYGB). Obes Surg. 2014;24(11):1926–32.Google Scholar
  41. 41.
    Prentice RL, Mossavar-Rahmani Y, Huang Y, et al. Evaluation and comparison of food records, recalls, and frequencies for energy and protein assessment by using recovery biomarkers. Am J Epidemiol. 2011;174(5):591–603.Google Scholar
  42. 42.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91.Google Scholar
  43. 43.
    de Castro CM, de Lima Montebelo MI, Rasera Jr I, et al. Effects of Roux-en-Y gastric bypass on resting energy expenditure in women. Obes Surg. 2008;18(11):1376–80.Google Scholar
  44. 44.
    Doucet E, St Pierre S, Almeras N, et al. Changes in energy expenditure and substrate oxidation resulting from weight loss in obese men and women: is there an important contribution of leptin? J Clin Endocrinol Metab. 2000;85(4):1550–6.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  2. 2.Department Surgery, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran

Personalised recommendations