Nutritional risks and deficiencies pre and post bariatric surgery: Recommendations for optimal dietary management

doi:10.3877/cma.j.issn.2095-9605.2018.04.001

Objective

This paper aims to summarise the key recommendations from the most recent literature, to support Chinese bariatric surgeons and their multidisciplinary teams in the optimal nutritional management of their patients. There is a growing body of evidence that recognises the risk of untreated nutritional deficiencies pre and post bariatric surgery. This paper will focus on the most prevalent and catastrophic of nutritional consequences.

Nutritional workup prior to surgery, in addition to postoperative nutrition follow up is highly desirable to avoid complications associated with restrictive diets and large variations in body mass ^[1]. Dietetic counselling to address presurgical nutritional deficiencies, appropriate use of presurgical Very Low-Calorie Diets (VLCD), postsurgical dietary protocol and adequate supplementation is prudent. Ensuring that patients are informed and prepared for the postsurgical restrictive dietary changes and lifestyle modifications is critical for long term success. Furthermore, longer term dietetic follow up can also monitor patient dietary compliance to avoid the extremes of nutritional deficiency.

Conclusions

Pre and post bariatric nutritional screening and long term nutritional follow up in addition to adherence to a life-long nutritional supplementation regimen, is critical for successful post-operative outcomes.

Key words: Dietetics, Caloric restriction, Bariatric surgery, Diet, Nutritional status, Dietary supplements, Malnutrition, Counselling

Table 1 Required supplementation to prevent micronutrient deficiency post bariatric surgery

Micronutrient	Requirement to prevent deficiency
Multivitamin and Mineral Supplement	2 adult multivitamin + mineral supplements/day (RYGB, SG) or 1 adult multivitamin + mineral supplement/day (LAGB) containing folic acid, thiamine, copper and iron
Thiamine	At least 12 mg/d but preferably 50 mg/d supplied by a routine multivitamin + mineral supplement
Vitamin B-12	Our review 500 mcg/d orally if adequately absorbed (LAGB, SG) or 500 mcg/d sublingual or 500-1?000 mcg/d intra-muscular every 1 or 3 months ASMBS 2013 350-500 mcg/d orally or sublingual or 1?000 mcg/month intra-muscular or sub-cutaneous
Vitamin D	3000 IU/d orally of vitamin D3
Iron	18 mg/d from routine multivitamin + mineral supplement for low risk patients (males and patients without history of anaemia) or 45-60 mg/d orally of elemental iron (females and RYGB, SG, BPD/DS patients)
Protein	Minimum of 60 g/d and up to 1.5 g/kg body weight/d

Table 1 Required supplementation to prevent micronutrient deficiency post bariatric surgery

Micronutrient	Requirement to prevent deficiency
Multivitamin and Mineral Supplement	2 adult multivitamin + mineral supplements/day (RYGB, SG) or 1 adult multivitamin + mineral supplement/day (LAGB) containing folic acid, thiamine, copper and iron
Thiamine	At least 12 mg/d but preferably 50 mg/d supplied by a routine multivitamin + mineral supplement
Vitamin B-12	Our review 500 mcg/d orally if adequately absorbed (LAGB, SG) or 500 mcg/d sublingual or 500-1?000 mcg/d intra-muscular every 1 or 3 months ASMBS 2013 350-500 mcg/d orally or sublingual or 1?000 mcg/month intra-muscular or sub-cutaneous
Vitamin D	3000 IU/d orally of vitamin D3
Iron	18 mg/d from routine multivitamin + mineral supplement for low risk patients (males and patients without history of anaemia) or 45-60 mg/d orally of elemental iron (females and RYGB, SG, BPD/DS patients)
Protein	Minimum of 60 g/d and up to 1.5 g/kg body weight/d

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