title: Twenty-four-hour energy and nutrient balance in weight stable postobese patients after biliopancreatic diversion.
abstract: To better understand the long-term weight stability of postobese patients who underwent biliopancreatic diversion (BPD), we studied 24-h energy and nutrient balance in eight women at least 3 yr after surgery (PO) and compared the results to those obtained in eight normal never-obese control women (C), matched by age and weight. Body composition was measured by dual-energy x-ray absorptiometry (DXA). All the patients were on an ad libitum diet; 24-h energy and nutrient intake were measured on the experimental day. Twenty-four-hour energy expenditure (EE) and 24-h nutrient oxidation rates were measured in a respiratory chamber, and energy and nutrient balances were calculated after correcting for 24-h fecal nutrient loss. No differences in body composition were found between PO and C. PO had a higher gross energy intake than C (10.6 +/- 3.4 vs. 8.0 +/- 2.2 MJ/d; p < 0.05); however, due to the higher energy fecal loss in PO as compared to C (2.4 +/- 1.3 vs. 0.09 +/- 0.01 MJ/day; p < 0.01), 24-h metabolizable energy intake (MEJ) was not different in the two groups. The energy fecal loss in the PO patients was mostly in the form of lipid. EE at 24 h was not different in PO as compared to C. Therefore energy balance, computed as the difference between 24-h MEI and 24-h EE, was similar in the two groups. Respiratory quotient was significantly higher in PO than in C (1.00 +/- 0.08 vs. 0.83 +/- 0.03; p < 0.01). Carbohydrate (-135 +/- 37 g/d in PO vs. 63 +/- 23 g/d in C; p < 0.001), and lipid (48 +/- 14 g/d in PO vs. -23 +/- 6 g/d in C; p < 0.001) balances were different in the two groups. We conclude that chronic lipid malabsorption was the main metabolic abnormality explaining the achievement of energy balance in postobese subjects after biliopancreatic diversion. A chronic reduction of lipid absorption seems to play a key role in the long-term weight stability of this group of postobese subjects.
authors.affiliation: Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: P A
authors.initials: PA
authors.lastname: Tataranni
authors.forename: G
authors.initials: G
authors.lastname: Mingrone
authors.forename: C A
authors.initials: CA
authors.lastname: Raguso
authors.forename: A
authors.initials: A
authors.lastname: De Gaetano
authors.forename: R M
authors.initials: RM
authors.lastname: Tacchino
authors.forename: M
authors.initials: M
authors.lastname: Castagneto
authors.forename: A V
authors.initials: AV
authors.lastname: Greco
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion; D001823:Body Composition; D001835:Body Weight; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D004435:Eating; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D050356:Lipid Metabolism; D009767:Obesity, Morbid / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*