Table 6 Grading of Evidence for associations between dietary intakes ( ≥ 24 months and beyond) and weight recurrence (up to 9-years) (6 studies)*.
Macronutrient Composition | Food Pattern | |||||
|---|---|---|---|---|---|---|
Carbohydrate | Protein | Fat | Fruit | All non-fruit core food groups | Diet Quality | |
Study Findings | No Association (6 studies, total N = 410, up to 5-years) [22, 23, 26, 28, 33, 46] | Inverse Association (1 study, total N = 37, up to 5-years) Level III: 1 AR study [26] (N = 37) No Association (5 studies, total N = 366, up to 9-years) [22, 23, 28, 33, 57] Level III: 3 LR studies [22, 23, 28], 1 AR study [33] (N = 269) Level IV: 1 AR study [57] (N = 97) | Positive Association (1 study, total N = 37, up to 5-years) Level III: 1 AR study [26] (N = 37) Inverse Association (1 study, total N = 86, up to 7-years) Level III: 1 LR study [35] (N = 86) No Association (4 studies, total N = 269, up to 5-years) [22, 23, 28, 33] Level III: 3 LR studies [22, 23, 28], 1 AR study [33] (N = 269) | Inverse Association (1 study, total N = 80, up to 3-years) [28] Level III: 1 LR study [28] (N = 80) No Association (3 studies, total N = 246, up to 9-years) [23, 33, 57] Level III: 1 LR study [23], 1 AR study [33] (N = 149) Level IV: 1 AR study [57] (N = 97) | No Association (4 studies, total N = 326, up to 9-years) [23, 28, 33, 57] Level III: 2 LR studies [23, 28], 1 AR study [33] (N = 229) Level IV: 1 AR study [57] (N = 97) | Inverse Association (1 study, total N = 80, up to 3-years) [28] Level III: 1 LR study [28] (N = 80) |
GRADING OF EVIDENCE | ||||||
Evidence Statement | Weight recurrence is not associated with carbohydrate or protein intakes at >24 months post-bariatric surgery. | An evidence statement could not be made due to inconsistent evidence. | Weight recurrence is not associated with core food group pattern at >24 months post-bariatric surgery. | Weight recurrence is inversely associated with a higher quality diet at >24months post-bariatric surgery. | ||
Evidence Base | B – Good. >2 Level III (cohort) studies with low risk of bias. Study findings are derived from cohort studies only. | C – Satisfactory. 1-2 Level III (cohort) studies with low risk of bias. Study findings are derived from cohort studies only. | C – Satisfactory. 1 Level III (cohort) study with low risk of bias. Study finding derived from single cohort study only. | |||
Consistencies | A – Excellent 6 out of 6 studies demonstrated no associations between weight recurrence and carbohydrate intake. | B – Good. 5 out of 6 studies demonstrated no associations between weight recurrence and protein intake. | D – Poor. Study findings highly inconsistent. ultiple study designs with varied risk of bias. | B – Good. 3 out of 4 studies demonstrated no associations between weight recurrence and fruit intake. | A – Excellent 4 out of 4 studies demonstrated no associations between weight recurrence and non-fruit food groups. | N/A Evidence derived from single study only. |
Clinical Impact | B – Good. Study findings highly consistent regardless of participant characteristics, study design, risk of bias, outcome measures or duration of follow-up. | D – Poor. Inconsistent study findings and design have affected ability to apply to practice. | B – Good. Study findings highly consistent regardless of participant characteristics, study design, risk of bias, outcome measures or duration of follow-up. | D – Poor. Evidence was derived from single cohort study only, which have affected ability to apply to practice. | ||
Generalizability | B – Good. All studies in adults at least one-year post-bariatric surgery in an outpatient setting. | |||||
Applicability | B – Good. Most studies were conducted with population from the Western context like the Australian bariatric context. | |||||
RECOMMENDATION 1 | GRADE OF RECOMMENDTION | |||||
Individualized diets with flexibility on macronutrient and food group composition can be recommended at two years or more post-bariatric surgery, as no composition or patterns showed associations with weight regain. | C Body of evidence provides some support for recommendation(s) but care should be taken in its application. | |||||
RECOMMENDATION 2 | GRADE OF RECOMMENDTION | |||||
Weight recurrence may be reduced with a better-quality diet, but more well designed RCTs or prospective cohort studies are required to strengthen this evidence base. | D Body of evidence is weak, and recommendation must be applied with caution. | |||||
