Nutritional Considerations After Bariatric SurgeryMichelle Lee, PhD, RD, LDNAssistant Professor-NutritionDepartment of Allied HealthCollege of Clinical and Rehabilitative SciencesETSU

Objectives:

•What are the short-term nutritional implications for individuals receiving bariatric surgery?

•What are the long-term nutritional implications for individuals receiving bariatric surgery?

Bariatric Surgery Trends•Between 2003 and 2008, bariatric surgeries

peaked in 2004 and has remained steady(1)

•Number of weight loss surgeries increased from 103,000 in 2003 to ~220,000 in 2008(2)

•Bariatric surgery in NOT a quick fix for morbid obesity

•There are nutritional implications for any bariatric surgery

Types of Bariatric Surgery• Restrictive

▫Laparoscopic adjustable gastric band (LAGB)▫Vertical banded gastroplasty (VBG)▫Intragastric balloon

• Malabsorptive▫Bilopancreatic diversion with duodenal switch

(BPD/DS)▫Jejunoileal bypass▫Bilopancreatic diversion (BPD)

• Primary Restrictive with a Malabsorptive Component▫Roux-en-Y gastric bypass (RYGB)

Laparoscopic Adjustable Gastric Band

Roux-en-Y Gastric Bypass

Nutritional Implications of Various Bariatric Surgeries(3,4)

•RYGB▫Malabsorption of Vit B12, Vit B1 (thiamin),

Vit D, Vit K, Folate, Iron, Calcium•LAGB

▫Folic Acid deficiency•BPD and BPD/DS

▫Vit A, D, E, and K deficiency, Protein-Calorie Malnutrition, Malabsorption of Calcium, Zinc, Selenium, Sodium, Potassium, Chloride, Phosphorus, Magnesium

Sites of Nutrient Absorption(4)

•Stomach▫Water, ethyl alcohol, copper, iodide,

fluoride, molybdemum, intrinsic factor•Duodenum

▫Calcium, iron, phosphorus, magnesium, copper, selenium, thiamin, riboflavin, niacin, biotin, folate, vitamins A, D, E, K

Sites of Nutrient Absorption(4)

•Jejunum▫Thiamin, riboflavin, niacin, pantothenate,

biotin, folate, vit B6, vit C, vit A, D, E, K, dipeptides, tripeptides, calcium, phosphorus, magnesium, iron, zinc, chromium, manganese, molybdenum, amino acids

•Ileum▫Vit C, folate, vit B12, vit D, vit K,

magnesium, bile salts/acids

Macronutrient Concerns

•Protein•Carbohydrates•Fat

Micronutrient Concerns

•Iron•Calcium and Vitamin D•Vitamin B12

•Folic acid•Thiamin•Zinc

Recommended Daily Supplements(4)

•Multivitamin with iron (prenatal vitamin will have adeq amount of folic acid)

•Calcium (citrate) with vitamin D (1200-1500 mg calcium with 800-1000 IU vitamin D)

•Oral vitamin B12 (500-1000 mcg)•Iron (65 mg/day in elemental form)

▫Vitamin C (to increase absorption of Iron)•Thiamin (10 mg/day)

Diet Progression After Bariatric Surgery(5)

•Clear Liquids•Full liquids•Pureed food•Mechanical soft food•Soft food•Regular diet

Diet Recommendations(3)

•Reduce food volume•Chew food very well•Slow pace of eating•No liquids with meals•Encourage fruits and vegetables as diet

progresses•Include high protein foods (at least

60g/day); may need protein supplements

References1. Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K,

Lane J. Trends in use of bariatric surgery. 2003-2008. J Am Coll Surg. 2011;213(2):261-266.

2. Weight-Control Information Network. Longitudinal assessment of bariatric surgery (LABS). NIH Publication No. 04-5573. http://win.niddk.nih.gov/publications/PDFs/LABS_FactSheet.pdf. Accessed February 25, 2012.

3. Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin N Am. 2007;91:499-514.

4. Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29-40.

5. Furtado LC. Nutritional management after Roux-en-Y gastric bypass. Br J Nurs. 2010;19(7):428-436.

Questions