scholarly journals POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 2 (Recommendation of macro and micronutrients and Nutritional Therapy)

2019 ◽  
pp. 8
Author(s):  
Keyword(s):  
Eating Habits ◽  
Nutritional Therapy ◽  
Hormonal Changes ◽  
Micronutrient Deficiencies ◽  
Intestinal Hormones ◽  
Gastric Restriction ◽  
Cultural Conditions ◽  
Post Surgery ◽  
Post Bariatric Surgery ◽  
Nutritional Complications

In order to minimize nutritional complications and create conditions for greater long-term success, it is important to predict, prevent and correct nutritional changes in pre-post surgery, with careful monitoring and nutritional supplementation according to guidelines. Priorities are the nutritional education of the patient/family, aiming at good eating habits, within their lifestyle and socioeconomic and cultural conditions. Nutrients Regular follow-up with a specialized nutritionist is essential to facilitate adequate weight loss and to assess the intake of micronutrients that may be inadequate due to the gastric restriction of the gastric band (BG) and sleeve gastrectomy (GV) techniques; of gastric restriction and dysabsorption in gastric bypass (BGYR) and minor gastric restriction and major dysabsorption in biliopancreatic bypass (BPD) and duodenal switch (BPD-DS). The latter 2 carry greater risk for protein malnutrition and micronutrient deficiencies. In all techniques except BG, there are functional and hormonal changes involved in the control of hunger and appetite, food intake, satiety, metabolic glucose change and changes in intestinal hormones such as ghrelin, GLP-1 and PYY.

scholarly journals Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery

2020 ◽  
Vol 30 (8) ◽  
pp. 3119-3126
Author(s):  
Malou A. H. Nuijten ◽  
Valerie M. Monpellier ◽  
Thijs M. H. Eijsvogels ◽  
Ignace M. C. Janssen ◽  
Eric J. Hazebroek ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Time Course ◽  
Mixed Model ◽  
Linear Regression Analysis ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Fat Free Mass ◽  
Mixed Model Analysis ◽  
Post Surgery ◽  
Post Bariatric Surgery

Abstract Purpose Fat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss. Materials and Methods A total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m2) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis. Results Highest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (β = 0.14, 95%CI = 0.10–0.18, P < .001), being male (β = 3.99, 95%CI = 2.86–5.12, P < .001), higher BMI (β = 0.13, 95%CI = 0.05–0.20, P = .002) and SG (β = 2.56, 95%CI = 1.36–3.76, P < .001) as determinants for a greater %FFML/WL. Conclusion Patients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss.

scholarly journals POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 1 (Nutritional Therapy in the evolution of diet and Dumping Syndrome)

2019 ◽  
pp. 7
Author(s):  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Nutritional Therapy ◽  
Dumping Syndrome ◽  
Surgical Team ◽  
Essential Nutrients ◽  
Nutritional Guidance ◽  
Adequate Hydration ◽  
Post Bariatric Surgery ◽  
Diet Consistency

Bariatric surgery is a form of treatment for morbid obesity (Body Mass Index – BMI – ≥ 40 Kg/m2) and, in patients with comorbidities such as diabetes mellitus from a BMI ≥ 35 Kg/m2. Bariatric diet protocols are defined by each surgical team and may vary in the progression of dietary consistency. However, they all share common nutritional goals such as: – Maximize weight loss and absorption of essential nutrients – Maintain adequate hydration – Avoid vomiting and dumping syndrome Nutritional guidance is based on a diet with minimal calories and high in essential nutrients, ensuring healing and minimizing loss of lean mass. The diet should reduce reflux, early satiety and dumping syndrome, at the same time increasing the expected weight loss for each period and, later, the maintenance of the acquired weight. Women who become pregnant should be monitored for adequate weight gain and specific supplementation, meeting the needs of the mother and fetus. Diet stage and progression The progression of diet consistency is based on post-surgical recommendation protocols. To improve the results, patients and family members already receive, in the preoperative period, a structured postoperative diet, with examples of menus and recommendations regarding the type of food, preparations, volume, in addition to basic notions of dietary technique.

scholarly journals Pre and postoperative deficiencies in iron, ferritin and B12 vitamin among portuguese patients undergoing bariatric surgery

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Mariana Santos Lopes ◽  
Bruno M. P. M. Oliveira ◽  
Olga Neves ◽  
Diva Melim ◽  
Paula Freitas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
World Health ◽  
Biochemical Data ◽  
Nutritional Deficiencies ◽  
Micronutrient Deficiencies ◽  
Multivitamin Supplementation ◽  
Anatomy And Physiology ◽  
Post Surgery ◽  
Frequent Use ◽  
Health Organization

AbstractIntroduction:According to the World Health Organization obesity it's the result of an abnormal or excessive body fat accumulation, which presents a high risk for the health. Bariatric surgery appears as an alternative to the conventional treatment for the morbid obese individuals. However, this type of intervention causes changes in the anatomy and physiology of the gastrointestinal tract, which may lead to the development of nutritional deficiencies in patients, in particular anemia.Aim:To evaluate micronutrient deficiencies in patients submitted to bariatric surgery in preoperative and postoperative periods, in particular iron, ferritin, and B12 vitamin.Methods:In this longitudinal study, we evaluated, retrospectively and prospectively, patients who attended the nutrition appointment at a central hospital. We completed a preexisting database containing anthropometric and biochemical data, adding biochemical data, at various periods: pre at 6th, 12th, 18th, 24th, 30th and 36th months post-surgery.Results:from the 121 patients submitted to bariatric surgery, 79,3% were female. The prevalence or iron deficiency reached 15%, ferritin deficiency reached almost 10% and B12 vitamin deficiency reached 18%. Furthermore there were deficiencies in other nutrients, e.g., vitamin D, magnesium and zinc. There was more than 85% adhesion to take the multivitamin supplementation and frequent use of specific supplementation.Conclusion:The prevalence of nutritional deficiencies is high, with a tendency to persist over time even with use of multivitamin supplementation, leading to the need for complementary supplementation, in particular to prevent the risk of anemia. Hence, periodic and long term monitoring is fundamental.

scholarly journals Severe malnutrition after bariatric surgery and clinic manifestations of infection

2019 ◽  
Vol 65 (9) ◽  
pp. 1151-1155
Author(s):  
Alice Avesani Cavotto Furlan ◽  
Marcia Varella Morandi Junqueira-Franco ◽  
Joyce Cristina Santos de Oliveira ◽  
José Wilson de Souza Favaris ◽  
Julio Sérgio Marchini ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Parenteral Nutrition ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Severe Malnutrition ◽  
Body Weight Reduction ◽  
Specialized Care ◽  
Post Bariatric Surgery ◽  
Nutritional Complications ◽  
Data Improvement

SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.

scholarly journals Management of Late Dumping Syndrome Induced Hypoglycemia With GLP-1R Agonist

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A416-A416
Author(s):  
Amna Ali Shaghouli ◽  
Razan Ballani ◽  
Naglaa Mesbah
Keyword(s):  
Bariatric Surgery ◽  
Glycemic Index ◽  
Gastric Inhibitory Polypeptide ◽  
Management Plan ◽  
Dumping Syndrome ◽  
Blood Glucose Monitoring ◽  
Post Surgery ◽  
Late Dumping Syndrome ◽  
Post Bariatric Surgery ◽  
Low Glycemic Index

Abstract Background: Late dumping syndrome is a prominent post-bariatric surgery side effect. Glucose-dependenthyperinsulinemia, induced by elevated gastric inhibitory polypeptide (GIP) and glucagon-likepeptide-1 (GLP-1) levels, leading to 2–3 hours post-prandial hypoglycemia. In literature, several managements are available: dietary changes, glucosidase inhibitor, andsomatostatin analogues. In case of failure of those strategies, partial or total pancreatectomy isindicated. Recently, management using GLP-1R agonists showed promising effect inmanagement of late dumping syndrome induced post-prandial hypoglycemia. (1)AimThe aim of this study was to investigate the effect of using GLP-1R agonists w/o low glycemicindex diet for treating dumping syndromes induced post-prandial hypoglycemia in post bariatricsurgery patients. Methods: A sample of 27 cases (25 females, 2 males) mean age 44.64, SD 10.2 of post-bariatric surgerywere managed using GLP-1R w/o low-glycemic index diet after being diagnosed with the latedumping syndrome induced post-prandial hypoglycemia for duration 1–3 years post-surgery. The27 were sent a survey of 13 questions related to their experience pre-and post-management plan. Results: Out of the 27 patients, 15 responded to the survey. The results showed 100% of the participantsdeveloped episodes of severe symptomatic late dumping syndrome with hypoglycemiasymptoms diagnosed after one and half years of their symptoms. 87% of them experiencedhypoglycemia post meals 2–3 hours.70 % of the participants got hypoglycemia more than 5episodes per week (less than 4.0 mmol/l) which was confirmed by blood glucose monitoring. After starting treatment with GLP-1R agonists with or without low-glycemic index diet, 87% ofthe participants reported that the hypoglycemia episodes were reduced. Out of those 87%participants 46% did not get any hypoglycemia episode and 54% of them experienced 1–2 timeshypoglycemia episodes. Conclusion: The results of the survey showed the successful reduction or prevention of late dumpinghypoglycemia episodes frequency post-bariatric surgery by GLP 1R agonist with or without lowglycemicindex diet. References: Non, A.N.H.W.H. and Black, H., 2012. Scope of the Problem. Am J Prev Med, 42, pp.563–70.Chiappetta, S. and Stier, C., 2017. A case report: Liraglutide as a novel treatment option in late dumping syndrome. Medicine, 96(12).

scholarly journals Medication Management after Bariatric Surgery: Providing Optimal Patient Care

2020 ◽  
Vol 9 (5) ◽  
pp. 1511 ◽  
Author(s):  
Daniel Porat ◽  
Arik Dahan
Keyword(s):  
Bariatric Surgery ◽  
Patient Care ◽  
Medication Management ◽  
Pharmacological Therapy ◽  
Clear Understanding ◽  
Drug Management ◽  
Post Surgery ◽  
Optimal Patient Care ◽  
Clinically Significant ◽  
Post Bariatric Surgery

Substantially altered gastrointestinal anatomy/physiology after bariatric surgery presents new challenges for the proper medication management of these patients; drug absorption and bioavailability may increase, decrease, or remain unchanged post surgery, depending on the specific drug in question and the type of bariatric procedure. In this article, we offer a concise overview of the various aspects of this clinically significant issue, aiming to provide readers with a clear understanding as well as practical tools to handle drug management post bariatric surgery. Realizing the potentially altered pharmacokinetics of various drugs after bariatric surgery is essential for providing optimal pharmacological therapy and overall patient care.

Efficacy of Fortification of School Meals with Ferrous Glycine Phosphate and Riboflavin against Anemia and Angular Stomatitis in Schoolchildren

2009 ◽  
Vol 30 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Malavika Vinodkumar ◽  
Srinivasa Rajagopalan
Keyword(s):  
Eating Habits ◽  
Binary Logistic Regression ◽  
Control School ◽  
Control Group ◽  
Micronutrient Deficiencies ◽  
Experimental School ◽  
Post Test ◽  
Multiple Micronutrient ◽  
And Control ◽  
Prevalence Of Anemia

Objective Multiple micronutrient deficiencies exist in many developing countries. We conducted a study to test the efficacy of ferrous glycine phosphate in reducing anemia and of riboflavin in reducing angular stomatitis when these micronutrients were added to the noon meal for schoolchildren. Methods A pre- and post-test design was used to study children 5 to 9 years of age, with an experimental and a control group. Two schools in the same locality in Chennai were chosen for the study. The experimental school had 65 children and the control school had 71 children, all of whom consumed a noon meal at the school daily. The children in the experimental school received a powder containing ferrous glycine phosphate and riboflavin, which was added to the meal during cooking every day for 6 months. The dosage was 28 mg of elemental iron and 1 mg of riboflavin per child per day. The children attended school for 5 days each week from Monday to Friday, except for holidays; they received the fortificants on 100 days during the 6-month period. There was no intervention in the control school. Children in the experimental and control groups were matched by socioeconomic status, age, and eating habits at baseline. All the children in the experimental and control schools were dewormed at baseline and at endline after 6 months. Hemoglobin was measured by the cynamethemoglobin method at baseline and endline. Results Binary logistic regression showed a significant (p < .001) time x group interaction for anemia. The prevalence of anemia in the experimental school was 69.0% at baseline and 32.8% after 100 days of intervention over 6 months, a statistically significant change ( p < .001). The prevalence of anemia in the control school was 91.5% at baseline and increased to 97.2% at endline; the increase was not statistically significant. The prevalence of angular stomatitis was reduced from 21% at baseline to 0% at endline in the experimental school, whereas it was 23% at baseline and 20% at endline in the control school. Conclusions The added fortificants reduced the prevalence of the micronutrient deficiencies.

scholarly journals Nutritional Deficiencies Post Bariatric Surgery: A Forgotten Area Impacting Long-Term Success and Quality of Life

2021 ◽  
Author(s):  
Wahiba Elhag ◽  
Walid El Ansari
Keyword(s):  
Bariatric Surgery ◽  
Water Soluble ◽  
Nutritional Deficiencies ◽  
Micronutrient Deficiencies ◽  
Preventive Strategies ◽  
Optimal Care ◽  
Before And After ◽  
Clinically Significant ◽  
Post Bariatric Surgery

Bariatric surgery (BS) results in significant weight loss and improvement of obesity associated comorbidities. Despite the benefits achieved with these operations, deficiencies of vitamins and other micronutrients are common. Such deficiencies may become clinically significant if not discovered and treated early. Therefore, it is imperative to undertake thorough screening, and have sound preventive strategies in place in order to make BS a safer procedure. This chapter will provide the multidisciplinary bariatric team with a comprehensive review of micronutrient deficiencies before and after bariatric surgery. The focus will be on the most common micronutrient deficiencies that are encountered in various types of BS procedures, including water soluble vitamins, fat-soluble vitamins, minerals and trace elements deficiencies, as well as protein malnutrition. The chapter starts with an overview of the causes of micronutrient deficiencies in patients with obesity and before undergoing BS. It reviews the screening of patients for preexisting micronutrient deficiencies prior to their BS. Then the chapter addresses the potential causes and mechanisms leading to such deficiencies after BS. It then conducts an in depth discourse of the prevalence of deficiencies by the type of BS, the presenting symptoms, and the investigations required for the diagnoses. The chapter will also discuss the management of each deficiency according to the severity of the symptoms. The chapter also reviews the recent updated guidelines for standard nutritional care post BS. We will finally conclude with a framework of the preventive strategies for optimal care to ensure long term success post-surgery.

scholarly journals Fortification of industrialized foods with vitamins

2006 ◽  
Vol 19 (2) ◽  
pp. 215-231 ◽  
Author(s):  
Selma Coelho Liberato ◽  
Helena Maria Pinheiro-Sant'Ana
Keyword(s):  
Vitamin D ◽  
Dairy Products ◽  
Eating Habits ◽  
Caloric Intake ◽  
The Elderly ◽  
Target Population ◽  
Micronutrient Deficiencies ◽  
Metabolic Defects ◽  
Fortified Food ◽  
The Common

Vitamins are essential to life. Inadequate eating habits, high caloric intake and metabolic defects lead to micronutrient deficiencies, affecting more than two billion people worldwide. The increasing intake of industrialized foods, combined with low vitamin stability has led to the common practice of adding these nutrients to processed foods. This review discusses the terminology, availability, intake and risk of hypervitaminosis, due to the intake and nutritional importance of foods fortified with vitamins. The addition of nutrients should occur in foods that are effectively consumed by the target population and must meet the real needs of a significant segment of the population. In Brazil, a total of 166 products available in supermarkets are vitamin-enriched. A 10-year study involving children and adolescents in Germany showed that 90% of those surveyed used at least one fortified food. During this 10-year period, 472 fortified products were consumed. The enrichment of foods should be based on the needs of each country and, if possible, regional needs. For instance, in order to increase its intake, Vitamin D is added to foods in Denmark during the winter, mainly for the elderly. However, in Brazil, there is no evidence of the need to fortify food with this vitamin. A survey showed that of the 76 enriched dairy products, 37 contained vitamin D. Food-fortification is a very important strategy to solve nutritional deficiency problems, but it can also cause many health problems.

scholarly journals Skin manifestations after bariatric surgery

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yada Itthipanichpong ◽  
Wilawan Damkerngsuntorn ◽  
Natsinee Tangkijngamvong ◽  
Suthep Udomsawaengsup ◽  
Patchaya Boonchayaanant ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Body Weight Loss ◽  
High Density Lipoproteins ◽  
Post Surgery ◽  
Excessive Body Weight ◽  
Successful Group ◽  
Successful Weight Loss ◽  
Clinical Trials Registry ◽  
Post Bariatric Surgery

Abstract Background Skin signs observed in morbid obesity may change as the weight reduces, especially post-bariatric surgery (BaS). Data concerning the skin findings exclusively in post-BaS patients remain limited. Methods Seventy post-BaS patients were examined for cutaneous abnormalities. The patients were divided into those with successful weight loss (% excessive body weight loss (EBWL) of at least 50%) and a non-successful group (%EBWL < 50%). Results Forty-six patients with successful weight loss demonstrated a significantly lower prevalence of acanthosis nigricans on the neck, axillae and inguinal areas, keratosis pilaris (KP) and pebble fingers. However, a higher prevalence of alopecia was observed. After adjustment with patients’ factors, KP (adjusted odds ratio (aOR) = 0.21, 95%CI 0.06–0.74, p = 0.02) and pebble fingers (aOR = 0.09, 95%CI 0.01–0.89, p = 0.04) remained significantly less likely in patients with successful weight loss. Laboratory results comparing pre- and post-surgery values revealed significant decreases in fasting plasma glucose, hemoglobin A1c, and triglyceride and an increase of high-density lipoproteins in both groups. However, significant decreases of liver aminotransferases (AST and ALT) were observed only in the successful group (p = 0.04, 0.003). Nonetheless, a decrease in vitamin B12 (p = 0.01) was observed in the successful group. Conclusion Weight loss after BaS provided an improvement for metabolic profiles. Successful weight reduction resulted in better skin improvement. However, nutritional supplements may be necessary. Trial registration Thai Clinical Trials Registry TCTR20171003002. Registered October 3. 2017, retrospectively registered.

Sign in / Sign up

Export Citation Format

Share Document