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Insights from the Impact of Meal Composition on Glucose Profile Towards Post-bariatric Hypoglycemia Management

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Abstract

Background/Aim

The need to improve post-bariatric hypoglycemia (PBH) diagnosis and clinical management is well recognized. Our aim was to evaluate the influence of meal nutritional composition on interstitial fluid glucose (IFG) profiles and symptom profile after Roux-en-Y gastric bypass (RYGB).

Methods

Seventeen subjects previously submitted to RYGB were allocated into two groups of symptomatic (n = 9) or control individuals (n = 8), according to spontaneous report of symptoms suggestive of hypoglycemia. Subjects were provided with a food and symptom diary (FSD) to record dietary intake and symptoms experienced, while using a flash glucose monitoring (FGM) system for 14 days.

Results

Postprandial symptom reports occurred in 70.5% of subjects (88.9% vs 50.0%, p = 0.0790, symptomatic vs control), although symptoms with concurrent IFG < 54 mg/dL and within 54 to 69 mg/dL were only observed in 31.9% and 4.8% of the events in the symptomatic vs control group, respectively (p = 0.0110). Daily glucose profiles, total energy, and macronutrients intake were not significantly different between the groups. However, nutritional composition of meals preceding reported symptoms had lower protein (3.2 g ± 1.0 g vs 7.7 g ± 0.5 g, p = 0.0286) or higher sugar (11.6 g ± 2.4 g vs 4.3 g ± 0.9 g, p = 0.0333) content.

Conclusions

Postprandial symptoms are often in patients after RYGB. Concurrent hypoglycemia only occurs in up to a third of the symptomatic episodes being more frequent in patients that spontaneously reported complaints. Hypoglycemia is more likely to be triggered by meals with a low protein or high sugar content. These findings highlight the putative role of meal composition in eliciting PBH and reinforce the need to refine nutritional intervention.

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Funding

The UMIB was funded by grants from the Foundation for Science and Technology (FCT) Portugal (UID/ Multi/00215/2019).

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Authors and Affiliations

  1. Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal

    Ana Raquel Marques, Carolina B. Lobato, Sofia S. Pereira, Marta Guimarães, Mário Nora & Mariana P. Monteiro

  2. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal

    Ana Raquel Marques, Carolina B. Lobato, Sofia S. Pereira, Marta Guimarães & Mariana P. Monteiro

  3. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Marta Guimarães, Sandra Faria & Mário Nora

Authors
  1. Ana Raquel Marques
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  2. Carolina B. Lobato
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  7. Mariana P. Monteiro
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Correspondence to Mariana P. Monteiro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Marques, A.R., Lobato, C.B., Pereira, S.S. et al. Insights from the Impact of Meal Composition on Glucose Profile Towards Post-bariatric Hypoglycemia Management. OBES SURG 30, 249–255 (2020). https://doi.org/10.1007/s11695-019-04147-1

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  • DOI: https://doi.org/10.1007/s11695-019-04147-1

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