Nutrition Deficiencies in Bariatric Surgery Bruce M. Wolfe MD Professor of Surgery Oregon Health &...
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![Page 1: Nutrition Deficiencies in Bariatric Surgery Bruce M. Wolfe MD Professor of Surgery Oregon Health & Science University.](https://reader036.fdocuments.in/reader036/viewer/2022062717/56649e1c5503460f94b0a747/html5/thumbnails/1.jpg)
Nutrition Deficiencies in Bariatric Surgery
Bruce M. Wolfe MDProfessor of Surgery
Oregon Health & Science University
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Potential Conflict of Interest
• Allergan• Covidian• EnteroMedics• Ethicon Endosurgery
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Deficiency due to:•Decreased intake•Vomiting•Malabsorption
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Protein-Calorie Malnutrition
• Uncommon/rare after LAGB, RYGBP• Prevented by 40-80g protein/day• May occur:– Dysfunctional eating habits/anorexia– Protracted vomiting– Malabsorptive procedure
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Shikora: Nutr Clin Prac 2007;22:35
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Nutritional Deficiency
• LAGB: – Vomiting
• RYGBP: – Iron– Calcium– Vitamin B12
• Malabsorption:– Protein– Fat-soluble vitamins– Minerals (Na, K, Mg, Zn)
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Dehydration
• Poor intake, difficulty catching up
• Decreased sodium intake from food
• Symptoms increased by medications
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Thiamine
• May be deficient pre-op
• Vomiting is the usual cause
• Encephalopathy, neuropathy
• Replace, then glucose
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Iron
• Absorbed in duodenum and jejunum in acid medium
• Measure serum Fe, TIBC
• Deficiency may precede anemia, heart failure
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Vitamin B12
• RYGBP deficiency 26-70%
• Macrocytic anemia, thrombocytopenia
• Neurologic derangements
• Oral or sublingual supplement
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Hollick MF; N Engl J Med 2007, 357;3:269
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Hollick MF; N Engl J Med 2007, 357;3:269
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Vitamin D, Calcium and Bone
• Calcium absorption• PTH inversely related• Bone Calcium• Supplement use leads to decreased fractures
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Hollick MF; N Engl J Med 2007, 357;3:272
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Non-skeletal Actions of Vitamin D
• Cancer• Autoimmune disease• Diabetes• CV disease• Schizophrenia, depression• Pulmonary function, asthma
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Vitamin D – Cancer
• <20 ng/ml increases by 30-50% the risk for:– Colon– Prostate– Breast
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Vitamin D
• CV disease: – HTN– CHF
• Autoimmune disease: – TIDM– MS
• Muscle function, athletic performance• Others
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Vitamin D
• IOM recommendations: – 200 IU/d <50y– 400 IU/d >50y– Inadequate sun: 800-1000 IU/d
• Replacement:– 50,000 IU weekly x 8 weeks, then q 2-4 weeksOr– 1000 IU D₃/d or 3000 IU D₂/d
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Bariatric Surgery Recommendations
• Pre-operative routine:– Iron– Vitamin D levels– Others as clinically indicated– Pre-operative supplementation– Treatment deficiency