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Management of Nutritional Complications

  • Liz Goldenberg
  • Alfons Pomp
Chapter

Abstract

Weight loss procedures change the manner in which the body intakes, digests, and/or absorbs food and its nutrients. The surgically altered gastrointestinal tract may cause potential nutritional complications. This can be the result of restriction of stomach capacity, hormonally altered appetite, or induced malabsorption via intestinal bypass or a combination of all these mechanisms. Surgeries that induce malabsorption, such as biliopancreatic diversion, with or without duodenal switch, or the distal (long limb) gastric bypass, are associated with more numerous and more serious nutritional complications. The more common postsurgical concerns include vomiting, loss of appetite, anemia, bowel habit changes, dumping syndrome, and maladaptive eating. Protein malnutrition and diseases of the ocular, musculoskeletal, and neurological systems are less frequently encountered. Healthcare professionals should be aware that the morbidly obese patient is by definition not a well-nourished patient. Many patients present with asymptomatic, unrecognized, and/or untreated nutrient deficiencies prior to undergoing surgery. Studies have demonstrated reduced levels of almost all of the vitamins and minerals in this population, including vitamins A, B6, B12 C, E, thiamin, and folate and the minerals iron, zinc, and selenium, as well as vitamin D deficiency with or without secondary hyperparathyroidism.

Keywords

Bariatric Surgery Gastric Bypass Sleeve Gastrectomy Hair Loss Biliopancreatic Diversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108. Epub 2008 May 19.PubMedCrossRefGoogle Scholar
  2. 2.
    Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin North Am. 2007;91(3):499–514, xii.PubMedCrossRefGoogle Scholar
  3. 3.
    Rudnicki SA. Prevention and treatment of peripheral neuropathy after bariatric surgery. Curr Treat Options Neurol. 2010;12(1): 29–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Ann Surg. 1986;52:594–8.Google Scholar
  6. 6.
    Amaral JF, Thompson WR, Caldwell MD, Martin HF, Randall HT. Prospective metabolic evaluation of 150 consecutive patients who underwent gastric exclusion. Am J Surg. 1984;147(4): 468–76.PubMedCrossRefGoogle Scholar
  7. 7.
    Ba F, Siddiqi ZA. Neurologic complications of bariatric surgery. Rev Neurol Dis. 2010;7(4):119–24.PubMedGoogle Scholar
  8. 8.
    Chang CG, Adams-Huet B, Provost DA. Acute post-gastric reduction surgery (APGARS) neuropathy. Obes Surg. 2004;14:182–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother. 2008;42(12):1851–8. Epub 2008 Nov 18.PubMedCrossRefGoogle Scholar
  10. 10.
    Scarano V, Milone M, Di Minno MN, Panariello G, Bertogliatti S, Terracciano M, Orlando V, Florio C, Leongito M, Lupoli R, Milone F, Musella M. Late micronutrient deficiency and neurological dysfunction after laparoscopic sleeve gastrectomy: a case report. Eur J Clin Nutr. 2012;66(5):645–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Poitou Bernert C, Ciangura C, Coupaye M, Czernichow S, Bouillot JL, Basdevant A. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33(1):13–24. Epub 2007 Jan 26.PubMedCrossRefGoogle Scholar
  12. 12.
    Powell MS, Fernandez Jr AZ. Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass. Surg Clin North Am. 2011;91(6):1203–24, viii.PubMedCrossRefGoogle Scholar
  13. 13.
    Kaushansky K, Kipps TJ. Chapter 37. Hematopoietic agents: growth factors, minerals, and vitamins. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th edn. 2011. http://www.accessmedicine.com/content.aspx?aID=16672174. Accessed 1 July 2012.
  14. 14.
    Stern SC, Cifu AS, Altkorn D. Chapter 6. I have a patient with anemia. How do I determine the cause? In: Stern SC, Cifu AS, Altkorn D, editors. Symptom to diagnosis: an evidence-based guide. 2nd edn. 2010. http://www.accessmedicine.com/content.aspx?aID=510083571. Accessed 1 July 2012.
  15. 15.
    Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy M, Collazo-Clavell ML, Spitz AD, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, AACE/TOS/ASMBS Guidelines. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17 suppl 1:S17, S19–S21, S39, S45, S50.Google Scholar
  16. 16.
    Jacques J. Micronutrition for the weight loss surgery patient. Edgemont: Matrix Medical Communications; 2006.Google Scholar
  17. 17.
    Apovian CM, Cummings S, Anderson W, Borud L, Boyer K, Day K, Hatchigian E, Hodges B, Patti ME, Pettus M, Perna F, Rooks D, Saltzman E, Skoropowski J, Tantillo MB, Thomason P. Best practice updates for multidisciplinary care in weight loss surgery. Obesity. 2009;17(5):871–9. Epub 2009 Feb 19.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Green R. Chapter 43. Anemia resulting from other nutritional deficiencies. In: Prchal JT, Kaushansky K, Lichtman MA, Kipps TJ, Seligsohn U, editors, Williams hematology. 8th edn. 2010. http://www.accessmedicine.com/content.aspx?aID=6130400. Accessed 7 July 2012.
  19. 19.
    Freeth A, Prajuabpansri P, Victory JM, Jenkins P. Assessment of selenium in Roux-en-Y gastric bypass and gastric banding surgery. Obes Surg. 2012;22(11):1660–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Sileri P, Franceschilli L, Cadeddu F, De Luca E, D’Ugo S, Tognoni V, Camperchioli I, Benavoli D, Di Lorenzo N, Gaspari AL, Gentileschi P. Prevalence of defaecatory disorders in morbidly obese patients before and after bariatric surgery. J Gastrointest Surg. 2012;16(1):62–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Hamdan K, Somers S, Chand M. Management of late postoperative complications of bariatric surgery. Br J Surg. 2011;98(10): 1345–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Anderson WA, Foresta L. Chapter 8. Nutritional consequences following bariatric surgery. In: Farraye FA, Forse A, editors. Bariatric surgery: a primer for your medical practice. Thorofare: Slack, Inc; 2006.Google Scholar
  23. 23.
    Rinaldi Schinkel E, Pettine SM, Adams E, Harris M. Impact of varying levels of protein intake on protein status indicators after gastric bypass in patients with multiple complications requiring nutritional support. Obes Surg. 2006;16(1):24–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002;27(5):396–404.Google Scholar
  25. 25.
    Neve H, Bhatti W, Soulsby C, Kincey J, Taylor TV. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 1996;1:63–5.CrossRefGoogle Scholar
  26. 26.
    Rogers C. Postgastrectomy nutrition. Nutr Clin Pract. 2011;26:126.PubMedCrossRefGoogle Scholar
  27. 27.
    Jen M, Yan AC. Syndromes associated with nutritional deficiency and excess. Clin Dermatol. 2010;28(6):669–85.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of GI Metabolic and Bariatric SurgeryWeill Medical College of Cornell University, New York Presbyterian HospitalNew YorkUSA

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