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Stavra A Xanthakos, MD, MS Pediatric Clinics of North America October 2009 56(5): 1105-1121
Background
in obese individuals
S Suspected mechanisms : S Nutrient dense food sources displaced by high-calorie nutrient poor foods and beverages
S These deficiencies are exacerbated with bariatric surgery S Critical to establish baseline nutritional status prior to
bariatric surgery
Purpose
deficiencies
S Review screening and supplementation to address
deficiencies
Bariatric Surgeries
Malabsorptive and Restrictive
Roux-en-Y gastric bypass (RYGB) most common Biliopancreatic Diversion with duodenal switch (BPD-DS) Biliopancreatic Diversion (BPD) rarely performed
S The risk increases as more of the small intestine is bypassed S Nutrients absorbed in the Proximal Small Intestine:
S S S S
Bariatric Surgeries
Purely Restrictive
Vertical Banded Gastroplasty (VBG) S Adjustable Gastric Band (AGB) S Vertical Sleeve Gastrectomy (VSG)
S Mechanical digestion and acid production are impaired with
Micronutrient Deficiencies
Supplementation
S Supplements should be not be Enteric-coated or time-released S Liquid, Suspension, or Chewable supplements are
recommended
S Liquid and chewable advisable for the 1st month post surgery
Iron
hyperparathyroidism
S Biomarker: Serum 25-OH-D, calcium, phosphorus, PTH
S Supplementation: S Calcium citrate w/Vit D3: 1200-1500 mg/day AGB 1800 mg/day-
S Deficiency more common in BPD-DS due to fat malabsorption S Baseline deficiencies: S Retinal and beta-carotene - 12.5 % S Vitamin E - 23% S Biomarker: S Vitamin A: plasma retinal S Vitamin E: plasma alpha-tocopherol S Vitamin K: prothrombin time S Supplementation: for BPD-DS 10,000 IU vit A and 300 g vit K
Vitamin B12
S Most common following RYGB 33%
S Baseline deficiency: 18% S Primary symptom: anemia, neurological dysfunction,
visual loss
S Biomarker: Serum vitamin B12 S Supplementation:
S
S
Vitamin B1
Folate
supplementation
S Primary symptom: Anemia S Biomarker: Red blood cell folate, plasma homocysteine
Vitamin C
inflammation
S Standard supplementation is sufficient to address deficiency
S Post surgery zinc deficiency: 36-51% S Most cases asymptomatic S Non-compliant supplementation can result in: Acrodermatitis
enteropathic-like rash
S Base-line zinc deficiency: 28% S Selenium deficiency can result in Cardiomyopathy S Copper deficiency S Screen for if unexplained anemia persists and with prolonged
zinc supplementation