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Nutrition Deficiencies in Bariatric Surgery

Nutrition Deficiencies in Bariatric Surgery. Bruce M. Wolfe MD Professor of Surgery Oregon Health & Science University. Potential Conflict of Interest. Allergan Covidian EnteroMedics Ethicon Endosurgery. Deficiency due to: Decreased intake Vomiting Malabsorption.

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Nutrition Deficiencies in Bariatric Surgery

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  1. Nutrition Deficiencies in Bariatric Surgery Bruce M. Wolfe MD Professor of Surgery Oregon Health & Science University

  2. Potential Conflict of Interest • Allergan • Covidian • EnteroMedics • Ethicon Endosurgery

  3. Deficiency due to: • Decreased intake • Vomiting • Malabsorption

  4. Protein-Calorie Malnutrition • Uncommon/rare after LAGB, RYGBP • Prevented by 40-80g protein/day • May occur: • Dysfunctional eating habits/anorexia • Protracted vomiting • Malabsorptive procedure

  5. Shikora: Nutr Clin Prac 2007;22:35

  6. Nutritional Deficiency • LAGB: • Vomiting • RYGBP: • Iron • Calcium • Vitamin B12 • Malabsorption: • Protein • Fat-soluble vitamins • Minerals (Na, K, Mg, Zn)

  7. Dehydration • Poor intake, difficulty catching up • Decreased sodium intake from food • Symptoms increased by medications

  8. Thiamine • May be deficient pre-op • Vomiting is the usual cause • Encephalopathy, neuropathy • Replace, then glucose

  9. Iron • Absorbed in duodenum and jejunum in acid medium • Measure serum Fe, TIBC • Deficiency may precede anemia, heart failure

  10. Vitamin B12 • RYGBP deficiency 26-70% • Macrocytic anemia, thrombocytopenia • Neurologic derangements • Oral or sublingual supplement

  11. Hollick MF; N Engl J Med 2007, 357;3:269

  12. HollickMF; N Engl J Med 2007, 357;3:269

  13. Vitamin D, Calcium and Bone • Calcium absorption • PTH inversely related • Bone Calcium • Supplement use leads to decreased fractures

  14. Hollick MF; N Engl J Med 2007, 357;3:272

  15. Non-skeletal Actions of Vitamin D • Cancer • Autoimmune disease • Diabetes • CV disease • Schizophrenia, depression • Pulmonary function, asthma

  16. Vitamin D – Cancer • <20 ng/ml increases by 30-50% the risk for: • Colon • Prostate • Breast

  17. Vitamin D • CV disease: • HTN • CHF • Autoimmune disease: • TIDM • MS • Muscle function, athletic performance • Others

  18. 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 weeks Or • 1000 IU D₃/d or 3000 IU D₂/d

  19. Bariatric Surgery Recommendations • Pre-operative routine: • Iron • Vitamin D levels • Others as clinically indicated • Pre-operative supplementation • Treatment deficiency

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