الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The prevalence of obesity is increasing all over the world; this high prevalence with its related comorbidities makes it a public health challenge. Changes in life style for weight loss have been disappointing, especially in extensively obese patients. In contrast, bariatric surgery is currently a good option for treatment of obesity, resulting in weight loss and improvement of related comorbidities. Current bariatric surgeries include JIB, gastric bypass, MGB, BPD, adjustable gastric band and LSG.
The general aim of this study was to evaluate the impact of LSG on nutritional status of morbidly obese patients. The specific objectives were toassess the anthropometric status in terms of body weight, body composition and rate of weight loss among patients included in this study, to estimate the blood levels of some minerals and vitamins preoperatively and postoperatively among LSG obese patients and to follow up improvement of any obesity related comorbid condition.
A one group pre-test post-test intervention study was conducted in the department of surgery of Alexandria Main University hospitals,in private hospitals and in the Nutrition clinic of the High Institute of Public Health in which the impact of LSG on nutritional status was studied on 55 obese patients. Target population are adult obese patients with BMI>40 kg/m2 or a BMI>35 kg/m2 with in the presence of comorbidities.
Preoperatively the patients were interviewed to determine the demographic characteristics of the sample, history was taken to determine the duration of obesity and to determine the presence of any obesity related comorbid conditions. Also patients were interviewed for a detailed dietary history and previous trials to lose weight. Anthropometric measurements were assessed in terms of height, body weight and BMI also body composition was measured to assess FM, FFM, muscle mass and body water. Laboratory analysis was performed to check fasting blood glucose, hemoglobin level, serum ferritin, serum iron, vitamin B12 and 25 hydroxy vitamin D.
All patients were followed up at 1-2 weeks after the surgery and at 1,2,3,6 months to assess changes in anthropometric measurements, record any GIT complications, observing and recording dietary management in the early postoperative period and prescribing daily multivitamin to all patients. Laboratory assessment was performed at the end of the sixth month to determine any changes from the preoperative levels.
The results of the present study can be summarized as follows:
• The mean age was 36.67 and the majority of patients were females (43 cases) and most of them had several trials to lose weight before surgery.
• Related comorbidities were assessed at 6 months postoperatively and showed a statistically significant improvement. Hypertension and T2DMshowed a 100% improvement, while OA, low back pain and OSA showed an improvement of 81.3%, 58.6% and 66.7% respectively.
• Anthropometric measurements (weight, BMI and WC) were measured preoperatively, at 2 weeks and at 1, 2,3 and 6 months postoperatively. There was a statistically significant decrease in all anthropometric measurements. The percentage of decrease of weight, BMI and WC at 6 months was 23.5%, 24% and 20.6% respectively. Body composition was also measured to assess FM, FFM, muscle mass and body water preoperatively and at 3 and 6 months postoperatively. The percent of decrease in FM at 6 months was 31.46% which was more than the decrease in FFM, muscle mass and body water which was 12.3%, 14.3%and 14.1% respectively. This decrease was also statistically significant.
• Vitamins and minerals (calcium, 25 hydroxy vitamin D, vitamin B12, serum ferritin and serum iron) were evaluated preoperatively and 6 months postoperatively to assess any micronutrientdeficiency after LSG. All these micronutrients showed a statistically significant decrease 6 months postoperatively.
• GIT complications were recorded in each follow up visit (2 weeks, 1month, 2 months, 3months and 6 months postoperative). The most common postoperative GIT complication was nausea (48 cases), nausea gradually decreased to disappear at 3 month postoperative follow up. GERD, vomiting and dysphagia were also recorded throughout the follow up period.
from our study the most important conclusions:
• A considerable decrease in weight, BMI and waist circumference occurs throughout the first six months of the postoperative period.
• Percentage of decrease in FM is more than that of FFM, muscle mass and body water.
• 25 hydroxy vitamin D and vitamin B12 are the most affected micronutrients after laparoscopic sleeve gastrectomy then to a lesser extent serum calcium, hemoglobin, serum ferritin and serum iron.
The most important recommendations:
• Repeated laboratory analysis to assess hemoglobin, serum ferritin, serum iron, calcium, vitamin B12and 25 hydroxy vitamin D should be done yearly and multivitamin supplement should be adjusted individually for each patient.
•Behavioral modification towards diet and physical activity is important for achieving reasonable weight loss postoperatively.