This study was published in the journal nutrients, was a multicenter study involving four Italian obesity centers: Salerno, Siena, Turin, and Vigevano.
In this study, a complex supplement containing whey protein (40 g), vitamin D (2,000 UI), L-leucine (40 mg), L-isoleucine (20 mg), and L-valine (20 mg) was administered for 1 day after surgery. It was shown to be more effective than protein supplements (whey protein 40 g) alone in alleviating the decline in FFM and MS without affecting the clinical status of patients for months.
Sleeve gastrectomy and dietary recommendations
Bariatric and metabolic surgery (BMS), including SG, is a surgical procedure for treating patients with severe to moderate obesity. These treatments have long-term benefits, particularly in reducing comorbidities in obese individuals worldwide.
Effective weight management requires reduction of fat mass (FM) and maintenance of metabolically active FFM. Typically, a patient will experience a significant decrease in both FM and FFM within her first month of her SG.
Significant reductions in FFM are associated with multiple deleterious conditions, including increased ease of weight regain, increased risk of sarcopenia, and muscle weakness. Therefore, it is essential to formulate dietary recommendations for effective weight management that help maintain adequate FFM and MS after BMS.
Most existing dietary recommendations focus solely on protein intake. To reduce undesirable FFM losses, average protein intake after BMS should range from 90 g to 120 g, or 1.1 g per kg of ideal body weight. It is also recommended to take 400 IU of vitamin D per day to improve skeletal muscle strength by an average of 17%.
Research details
This study recruited a total of 57 obese participants (38 women, 19 men, mean age 43 years) who underwent SG between January and July 2023. All patients were evaluated the day before SG (baseline) and 1 month after surgery. During the follow-up period, participants were advised not to change their physical activity patterns.
A single postoperative isocaloric diet was formulated to ensure that all participants from different bariatric centers received a similar diet. Selected participants were non-randomly assigned to P+BCAA+Vit D group (n = 31) and protein-only group (n = 26) based on specific conditions.
Each participant’s body composition was measured using bioelectrical impedance analysis (BIA) and absolute grip strength was measured using a grip dynamometer.
P+BCAA+vitamin D supplementation was found to be more effective than protein alone in preventing MS and FFM in participants.
The authors concluded that adequate daily intake of BCAA and vitamin D along with whey protein could significantly improve FFM and MS during the first month after SG.
Mechanism of action
Isoleucine and valine are two BCAAs that play an important role in maintaining muscle mass hypertrophy. Leucine is another BCAA that promotes anabolic effects by increasing protein synthesis and decreasing protein breakdown, ultimately promoting a net balance of muscle and protein.
Leucine’s regulatory role in muscle protein synthesis and long-term effects on body composition support leucine intake for healthy muscle tissue. Mechanistically, BCAAs interact with the insulin metabolic pathway, thereby altering protein synthesis and maintaining her FFM during caloric restriction.
Vitamin D supplementation promotes calcium accumulation in the sarcoplasmic reticulum by increasing calcium-binding receptor levels. Additionally, it improves the effectiveness of calcium binding sites, enhances phosphate transport across cell membranes, and promotes muscle cell proliferation and differentiation. Low vitamin D levels result in greater loss of FFM and MS.
sauce: Nutrients
doi: 10.3390/nu16101448
“Adding branched-chain amino acids and vitamin D to whey protein is more effective than protein alone in maintaining lean mass and muscle strength during the first month after sleeve gastrectomy.”
Author: Schiavo et al.
