Protein Supplement Tolerability and Patient Satisfaction after Bariatric Surgery

Abstract

Purpose: Disproportional fat-free mass loss often occurs post-bariatric surgery, partly due to insufficient protein intake during the post-surgery recovery phase. We compared five protein-enhancing strategies (PES) on patient tolerability, satisfaction and protein intake.

Materials and methods: Ninety-four participants, scheduled for bariatric surgery, were enrolled and allocated to either of the following: (1) whey powder, (2) hydrolysed collagen powder, (3) plant-based powder, (4) protein-rich products, (5) protein gel, or control. PES groups were instructed to add 30 g of powder or 2 gels or protein products to their diet. Patient satisfaction and tolerability were evaluated with questionnaires. Dietary intake was assessed prior to and during PES use.

Results: Seven patients dropped out (i.e. loss of contact, personal reasons or post-surgery complications) yielding an analytical cohort of 87 participants. The majority of patients (61%) did not experience dietary complaints from PES and could use PES ≥ 5 days of the week. PES non-usage was mainly related to taste dislike (58%). Hydrolysed collagen scored highest on tolerability and satisfaction: 86% of the participants could use HC ≥ 5 days and 71% were satisfied with the product. PES increased protein intake from 54.7 ± 21.5 g/day to 64.7 ± 23.4 g/day during the intervention (p = 0.002), which differed from the control group (+ 10.1 ± 24.5 g/day vs. - 6.3 ± 23.8 g/day for controls, p = 0.019). Whey showed the highest increase, namely + 18.3 ± 16.3 g/day (p = 0.009).

Conclusion: PES were tolerated by the majority of participants, and an improved protein intake with PES use was seen. However, the taste of the products could be improved to further enhance satisfaction and tolerability.

Keywords: Dietary Complaints; Protein Intake; Roux-en-Y Gastric Bypass; Sleeve Gastrectomy.

Fig. 1

Overview of study design. Participants were recruited pre-surgery after which they were allocated to one of six study arms: 5 PES arms and 1 control group. At t0, participants underwent bariatric surgery. Baseline measurements were taken in the third week post-surgery, and in week 4, the intervention took place. After the fourth week, participants received the final digital questionnaire on tolerability and satisfaction with PES

Fig. 2

Participant flowchart: inclusion and drop-out

Fig. 3

Tolerability and PES intake: Self-reported intake of protein-enhancing strategies with a number of days of protein-enhancing strategy use and b relative average daily intake of the protein-enhancing strategy to advised daily dosage and c self-reported dietary complaints after supplement use for the protein-enhancing strategies and overall dietary complaints not related to PES use for all study arms. HC, hydrolysed collagen; PRP, protein-rich products; Gel, protein gel. *Significant difference compared to HC; #significant difference compared to PRP

Fig. 4

User satisfaction with protein-enhancing strategies for three statements on a 5-point Likert scale: ease of use, taste and overall satisfaction. HC, hydrolysed collagen; PRP, protein-rich products; Gel, protein gel

Fig. 5

Overall daily protein intake at baseline and intervention week for a the protein-enhancing strategies combined and control and b subdivided per protein-enhancing strategy. The red line depicts the advised protein intake of 60 g per day according to current guidelines. Bar charts showing median and interquartile range. CON, control; INT, PES arms combined; HC, hydrolysed collagen; PRP, protein-rich products