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Anthropometric Evaluation and Micronutrients Intake in Patients Submitted to Laparoscopic Roux-en-Y Gastric Bypass with a Postoperative Period of ≥1 Year

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Abstract

Background

Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies.

Methods

The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI).

Results

There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake.

Conclusions

Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.

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References

  1. National Collaborating Centre for Primary Care. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London: National Institute for Health and Clinical Excellence; 2006.

    Google Scholar 

  2. Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  3. Khwaja HA, Bonanomi G. Bariatric surgery: techniques, outcomes and complications. Curr Anaes Crit Care. 2010;21(1):31–8.

    Article  Google Scholar 

  4. Kerrigan D, Magee C, Mitchell AI. Bariatric surgery. Surgery. 2011;29(11):581–5.

    Google Scholar 

  5. Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.

    Article  PubMed  Google Scholar 

  6. Harbottle L. Audit of nutritional and dietary outcomes of bariatric surgery patients. Obes Rev Off J Int Assoc Study Obes. 2011;12(3):198–204.

    Article  CAS  Google Scholar 

  7. Davies D, Baxter J. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;1:1–9.

    Google Scholar 

  8. Kulick D, Hark L, Deen D. The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc. 2010;110(4):593–9.

    Article  PubMed  Google Scholar 

  9. Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.

    CAS  PubMed  Google Scholar 

  10. Buchwald H, Ikramuddin S, Dorman RB, et al. Management of the metabolic/bariatric surgery patient. Am J Med. 2011;124(12):1099–105.

    Article  PubMed  Google Scholar 

  11. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.

    Article  CAS  PubMed  Google Scholar 

  12. Blume CA, Boni CC, Casagrande DS, et al. Nutritional profile of patients before and after Roux-en-y gastric bypass: 3-year follow-up. Obes Surg. 2012;22(11):1676–85.

    Article  PubMed  Google Scholar 

  13. World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Service. WHO. 1995; 854.

  14. Gallagher D, Heymsfield SB, Heo M, et al. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694–701.

    CAS  PubMed  Google Scholar 

  15. World Health Organization. Obesity: preventing and managing the global epidemic. 2000.

  16. Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.

    Article  PubMed  Google Scholar 

  17. Lee R, Nieman D. Nutritional assessment. 4th ed. UK: McGraw-Hill; 2007.

    Google Scholar 

  18. Institute of Medicine Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. National Academy. 2002.

  19. Food and Nutrition Board, Institute of Medicine: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, B. Washington: National Academies Press (www.nap.edu).

  20. Lier HØ, Biringer E, Stubhaug B, et al. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42.

    Article  PubMed  Google Scholar 

  21. Department of Social and Demographic Statistics. Documento metodológico. Instituto Nacional de Estatística. 2006.

  22. Mechanick JI, Kushner RF, Sugerman HJ, et al. Surg Obes Relat Dis. 2008;4(5):109–84.

    Article  Google Scholar 

  23. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  PubMed  Google Scholar 

  24. Faria SL, de Oliveira KE, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20(2):135–9.

    Article  PubMed  Google Scholar 

  25. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analyses. JAMA. 2004;292(14):1724–237.

    Article  CAS  PubMed  Google Scholar 

  26. Kruseman M, Leimgruber A, Zumbach F, et al. Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. J Am Diet Assoc. 2010;110(4):527–34.

    Article  PubMed  Google Scholar 

  27. Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.

    Article  PubMed  Google Scholar 

  28. Turk MW, Yang K, Hravnak M, et al. Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs. 2009;24(1):58–80.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609–14.

    Article  PubMed  Google Scholar 

  30. Welch G, Wesolowski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. Obes Surg. 2008;18(5):517–24.

    Article  PubMed  Google Scholar 

  31. Freire RH, Borges MC, Alvarez-Leite JI, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28(1):53–8.

    Article  PubMed  Google Scholar 

  32. Rossi R, Santos M, de Souza F, et al. Nutrient intake of women 3 years after Roux-en-Y gastric bypass. Obes Surg. 2012;22(10):1548–53.

    Article  Google Scholar 

  33. Bavaresco M, Paganini S, Lima TP, et al. Nutritional course of patients submitted to bariatric surgery. Obes Surg. 2010;20:716–21.

    Article  PubMed  Google Scholar 

  34. Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.

    Article  PubMed  Google Scholar 

  35. Malinowski S. Nutrition and metabolic complications of bariatric surgery. Am J Med Sci. 2006;28:481–4.

    Google Scholar 

  36. Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition. Part A: vitamins. Obes Surg. 2008;8(7):870–6.

    Article  Google Scholar 

  37. Kushner RF. Micronutrient deficiencies and bariatric surgery. Curr Opin Endocrinol Diabetes. 2006;13:405–11.

    Article  CAS  Google Scholar 

  38. Skroubis G, Anesidis S, Kehagias I, et al. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16(4):488–95.

    Article  PubMed  Google Scholar 

  39. Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.

    Article  PubMed  Google Scholar 

  40. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    Article  CAS  PubMed  Google Scholar 

  41. Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2(5):436–42.

    Article  CAS  PubMed  Google Scholar 

  42. Mallory GN, Macgregor AM. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg. 1991;1(1):69–72.

    Article  PubMed  Google Scholar 

  43. Shikora S, Claros L, Furtado M. Bariatric surgery. In: Marian M, Russell MK, Shikora SA, editors. Clinical nutrition for surgical patients. USA: Jones and Bartlett; 2008.

    Google Scholar 

  44. Aills L, Blankenship J, Buffington C, et al. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–S108.

    Article  PubMed  Google Scholar 

  45. Ruz M, Carrasco F, Rojas P, et al. Iron absorption and iron status are reduced after Roux-en-Y gastric. Am J Clin Nutr. 2009;90:527–32.

    Article  CAS  PubMed  Google Scholar 

  46. Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–203.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rua Alfredo Rebelo, Casais de Baixo, 2050-360 Azambuja, Lisbon, Portugal

    Tânia Mercachita

  2. Hospital Egas Moniz, Lisbon, Portugal

    Zélia Santos

  3. BaroClinic, Lisbon, Portugal

    Jorge Limão

  4. Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal

    Elisabete Carolino & Lino Mendes

Authors
  1. Tânia Mercachita
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  2. Zélia Santos
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  3. Jorge Limão
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  4. Elisabete Carolino
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  5. Lino Mendes
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Correspondence to Tânia Mercachita.

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Mercachita, T., Santos, Z., Limão, J. et al. Anthropometric Evaluation and Micronutrients Intake in Patients Submitted to Laparoscopic Roux-en-Y Gastric Bypass with a Postoperative Period of ≥1 Year. OBES SURG 24, 102–108 (2014). https://doi.org/10.1007/s11695-013-1057-1

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  • DOI: https://doi.org/10.1007/s11695-013-1057-1

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