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Nutritional Considerations After Bariatric Surgery

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Presentation on theme: "Nutritional Considerations After Bariatric Surgery"— Presentation transcript:

1 Nutritional Considerations After Bariatric Surgery
Michelle Lee, PhD, RD, LDN Assistant Professor-Nutrition Department of Allied Health College of Clinical and Rehabilitative Sciences ETSU

2 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?

3 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

4 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)

5 Laparoscopic Adjustable Gastric Band

6 Roux-en-Y Gastric Bypass

7 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

8 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

9 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


11 Macronutrient Concerns
Protein Carbohydrates Fat

12 Micronutrient Concerns
Iron Calcium and Vitamin D Vitamin B12 Folic acid Thiamin Zinc

13 Recommended Daily Supplements(4)
Multivitamin with iron (prenatal vitamin will have adeq amount of folic acid) Calcium (citrate) with vitamin D ( mg calcium with IU vitamin D) Oral vitamin B12 ( mcg) Iron (65 mg/day in elemental form) Vitamin C (to increase absorption of Iron) Thiamin (10 mg/day)

14 Diet Progression After Bariatric Surgery(5)
Clear Liquids Full liquids Pureed food Mechanical soft food Soft food Regular diet

15 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

16 References Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery J Am Coll Surg ;213(2): Weight-Control Information Network. Longitudinal assessment of bariatric surgery (LABS). NIH Publication No Accessed February 25, 2012. Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin N Am. 2007;91: Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29-40. Furtado LC. Nutritional management after Roux-en-Y gastric bypass. Br J Nurs. 2010;19(7):

17 Questions

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