Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Obesity Reports
Published in: Current Obesity Reports 3/2017

01-09-2017 | Health Services and Programs (R Welbourn, Section Editor)

Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update

Authors: Michael A. Via, Jeffrey I. Mechanick

Published in: Current Obesity Reports | Issue 3/2017

Login to get access

Abstract

Purpose of Review

The continued success of bariatric surgery to treat obesity and obesity-associated metabolic conditions creates a need for a strong understanding of clinical nutrition both before and after these procedures.

Recent Findings

Surgically induced alteration of gastrointestinal physiology can affect the nutrition of individuals, especially among those who have undergone malabsorptive procedures. While uncommon, a subset of patients may develop protein-calorie malnutrition. In these cases, nutrition support should be tailored to the severity of malnutrition.

Summary

Among all patients who undergo bariatric surgery, high rates of micronutrient deficiencies have been observed. To mitigate these deficiencies, empiric supplementation with multivitamins, calcium citrate, and vitamin D is generally recommended. Periodic surveillance should be performed for commonly deficient micronutrients, including thiamin (B1), folate (B9), cobalamin (B12), iron, and vitamin D. Following Roux-en-Y gastric bypass, serum levels of copper and zinc should also be monitored. In addition, lipid-soluble vitamins should be monitored following biliopancreatic diversion with/without duodenal switch.
Literature
1.
Khorgami Z, Shoar S, Andalib A, Aminian A, Brethauer SA, Schauer PR. Trends in utilization of bariatric surgery, 2010–2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;
2.
Strohmayer E, Via MA, Yanagisawa R. Metabolic management following bariatric surgery. Mt. Sinai J Med. 2010;77(5):431–45.CrossRefPubMed
3.
Fox SR. The use of the biliopancreatic diversion as a treatment for failed gastric partitioning in the morbidly obese. Obes Surg. 1991;1(1):89–93.CrossRefPubMed
4.
Ledoux S, Msika S, Moussa F, Larger E, Boudou P, Salomon L, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg. 2006;16(8):1041–9.CrossRefPubMed
5.
Perrone F, Bianciardi E, Ippoliti S, Nardella J, Fabi F, Gentileschi P. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years. Updates Surg. 2017;
6.
Laurenius A, Larsson I, Melanson KJ, Lindroos AK, Lonroth H, Bosaeus I, et al. Decreased energy density and changes in food selection following Roux-en-Y gastric bypass. Eur J Clin Nutr. 2013;67(2):168–73.CrossRefPubMed
7.
Aron-Wisnewsky J, Verger EO, Bounaix C, Dao MC, Oppert JM, Bouillot JL, et al. Nutritional and protein deficiencies in the short term following both gastric bypass and gastric banding. PLoS One. 2016;11(2):e0149588.CrossRefPubMedPubMedCentral
8.
Daniel H, Zietek T. Taste and move: glucose and peptide transporters in the gastrointestinal tract. Exp Physiol. 2015;100(12):1441–50.CrossRefPubMed
9.
Mace OJ, Lister N, Morgan E, Shepherd E, Affleck J, Helliwell P, et al. An energy supply network of nutrient absorption coordinated by calcium and T1R taste receptors in rat small intestine. J Physiol. 2009;587(1):195–210.CrossRefPubMed
10.
Mace OJ, Affleck J, Patel N, Kellett GL. Sweet taste receptors in rat small intestine stimulate glucose absorption through apical GLUT2. J Physiol. 2007;582(Pt 1):379–92.CrossRefPubMedPubMedCentral
11.
Bhutta HY, Deelman TE, le Roux CW, Ashley SW, Rhoads DB, Tavakkoli A. Intestinal sweet-sensing pathways and metabolic changes after Roux-en-Y gastric bypass surgery. Am J Physiol Gastrointest Liver Physiol. 2014;307(5):G588–93.CrossRefPubMedPubMedCentral
12.
Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMed
13.
Suarez Llanos JP, Fuentes Ferrer M, Alvarez-Sala-Walther L, Garcia Bray B, Medina Gonzalez L, Breton Lesmes I, et al. Protein malnutrition incidence comparison after gastric bypass versus biliopancreatic diversion. Nutr Hosp. 2015;32(1):80–6.PubMed
14.
• Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract. 2013;19(2):337–72.CrossRefPubMedPubMedCentral
15.
Mala T. The gastric remnant in Roux-en-Y gastric bypass: challenges and possibilities. J Clin Gastroenterol. 2016;50(7):527–31.CrossRefPubMed
16.
Pereira-da-Silva L, Pitta-Gros Dias M, Virella D, Serelha M. Osmolality of elemental and semi-elemental formulas supplemented with nonprotein energy supplements. J Hum Nutr Diet. 2008;21(6):584–90.CrossRefPubMed
17.
Vilallonga R, van de Vrande S, Himpens J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc. 2013;27(12):4640–8.CrossRefPubMed
18.
19.
Ezquerro S, Mendez-Gimenez L, Becerril S, Moncada R, Valenti V, Catalan V, et al. Acylated and desacyl ghrelin are associated with hepatic lipogenesis, beta-oxidation and autophagy: role in NAFLD amelioration after sleeve gastrectomy in obese rats. Sci Rep. 2016;6:39,942.CrossRef
20.
Xu Z, Li Y, Wang J, Wu B, Li J. Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults. Clin Nutr. 2012;31(2):217–23.CrossRefPubMed
21.
Jones CJ, Calder PC. Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: A systematic review. Clin Nutr. 2016;
22.
23.
Segaran E. Provision of nutritional support to those experiencing complications following bariatric surgery. Proc Nutr Soc. 2010;69(4):536–42.CrossRefPubMed
24.
van Gemert WG, Westerterp KR, Greve JW, Soeters PB. Reduction of sleeping metabolic rate after vertical banded gastroplasty. Int J Obes Relat Metab Disord. 1998;22(4):343–8.CrossRefPubMed
25.
Schneider J, Peterli R, Gass M, Slawik M, Peters T, Wolnerhanssen BK. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass lead to equal changes in body composition and energy metabolism 17 months postoperatively: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(3):563–70.CrossRefPubMed
26.
Hirsch KR, Smith-Ryan AE, Blue MN, Mock MG, Trexler ET. Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults. J Endocrinol Invest. 2017;
27.
Alves VG, da Rocha EE, Gonzalez MC, da Fonseca RB, Silva MH, Chiesa CA. Assessement of resting energy expenditure of obese patients: comparison of indirect calorimetry with formulae. Clin Nutr. 2009;28(3):299–304.CrossRefPubMed
28.
de Castro CM, de Lima Montebelo MI, Rasera I Jr, de Oliveira AV Jr, Gomes Gonelli PR, Aparecida Cardoso G. Effects of Roux-en-Y gastric bypass on resting energy expenditure in women. Obes Surg. 2008;18(11):1376–80.CrossRef
29.
Choban P, Dickerson R, Malone A, Worthington P, Compher C. A.S.P.E.N. Clinical guidelines: nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr. 2013;37(6):714–44.CrossRefPubMed
30.
31.
Schollenberger AE, Karschin J, Meile T, Kuper MA, Konigsrainer A, Bischoff SC. Impact of protein supplementation after bariatric surgery: a randomized controlled double-blind pilot study. Nutrition. 2015;32(2):186–92.CrossRefPubMed
32.
Herring LY, Stevinson C, Carter P, Biddle SJ, Bowrey DJ, Sutton CD, et al. The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: A randomised controlled trial. Int J Obes (Lond). 2017;
33.
Campanha-Versiani L, Pereira DA, Ribeiro-Samora GA, Ramos AV, de Sander Diniz MF, De Marco LA, et al. The effect of a muscle weight-bearing and aerobic exercise program on the body composition, muscular strength, biochemical markers, and bone mass of obese patients who have undergone gastric bypass surgery. Obes Surg. 2017;
34.
Bae J, Shade J, Abraham A, Abraham B, Peterson L, Schneider EB, et al. Effect of mandatory centers of excellence designation on demographic characteristics of patients who undergo bariatric surgery. JAMA Surg. 2015;150(7):644–8.CrossRefPubMed
35.
Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–20. discussion 420–412CrossRefPubMedPubMedCentral
36.
Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. 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.CrossRefPubMed
37.
Coupaye M, Puchaux K, Bogard C, Msika S, Jouet P, Clerici C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.CrossRefPubMed
38.
Marinari GM, Murelli F, Camerini G, Papadia F, Carlini F, Stabilini C, et al. A 15-year evaluation of biliopancreatic diversion according to the Bariatric Analysis Reporting Outcome System (BAROS). Obes Surg. 2004;14(3):325–8.CrossRefPubMed
39.
Liu D, Ke Z, Luo J. Thiamine deficiency and neurodegeneration: the interplay among oxidative stress, endoplasmic reticulum stress, and autophagy. Mol Neurobiol. 2016;
40.
41.
Matrana MR, Vasireddy S, Davis WE. The skinny on a growing problem: dry beriberi after bariatric surgery. Ann Intern Med. 2008;149(11):842–4.CrossRefPubMed
42.
Bhardwaj A, Watanabe M, Shah JR. A 46-yr.-old woman with ataxia and blurred vision 3 months after bariatric surgery. Am J Gastroenterol. 2008;103(6):1575–7.CrossRefPubMed
43.
Moat SJ, Lang D, McDowell IF, Clarke ZL, Madhavan AK, Lewis MJ, et al. Folate, homocysteine, endothelial function and cardiovascular disease. J Nutr Biochem. 2004;15(2):64–79.CrossRefPubMed
44.
Zhao R, Matherly LH, Goldman ID. Membrane transporters and folate homeostasis: intestinal absorption and transport into systemic compartments and tissues. Expert Rev. Mol Med. 2009;11:e4.CrossRefPubMedPubMedCentral
45.
46.
• Pellitero S, Martinez E, Puig R, Leis A, Zavala R, Granada ML, et al. Evaluation of vitamin and trace element requirements after sleeve gastrectomy at long term. Obes Surg. 2017; A prospective cohort trial that demonstrates micronutrient deficiencies up to 5 years following LSG
47.
Homan J, Betzel B, Aarts EO, Dogan K, van Laarhoven KJ, Janssen IM, et al. Vitamin and mineral deficiencies after biliopancreatic diversion and biliopancreatic diversion with duodenal switch—the rule rather than the exception. Obes Surg. 2015;25(9):1626–32.CrossRefPubMed
48.
• Coupaye M, Riviere P, Breuil MC, Castel B, Bogard C, Dupre T, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83. A prospective trial comparing micronutrient deficiencies among patients that have undergone LSG or RYGB CrossRefPubMed
49.
Baltaci D, Deler MH, Turker Y, Ermis F, Iliev D, Velioglu U. Evaluation of serum Vitamin B12 level and related nutritional status among apparently healthy obese female individuals. Niger J Clin Pract. 2017;20(1):99–105.CrossRefPubMed
50.
Moore CE, Sherman V. Effectiveness of B vitamin supplementation following bariatric surgery: rapid increases of serum vitamin B12. Obes Surg. 2013;25(4):694–9.CrossRef
51.
Grasbeck R. Hooked to vitamin B12 since 1955: a historical perspective. Biochimie. 2013;95(5):970–5.CrossRefPubMed
52.
Punchai S, Hanipah ZN, Meister KM, Schauer PR, Brethauer SA, Aminian A. Neurologic manifestations of vitamin B deficiency after bariatric surgery. Obes Surg. 2017;
53.
Aasheim ET, Bjorkman S, Sovik TT, Engstrom M, Hanvold SE, Mala T, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009;90(1):15–22.CrossRefPubMed
54.
Cupa N, Schulte DM, Ahrens M, Schreiber S, Laudes M. Vitamin B6 intoxication after inappropriate supplementation with micronutrients following bariatric surgery. Eur J Clin Nutr. 2015;69(7):862–3.CrossRefPubMed
55.
Gobato RC, Seixas Chaves DF, Chaim EA. Micronutrient and physiologic parameters before and 6 months after RYGB. Surg Obes Relat Dis. 2014;10(5):944–51.CrossRefPubMed
56.
Riess KP, Farnen JP, Lambert PJ, Mathiason MA, Kothari SN. Ascorbic acid deficiency in bariatric surgical population. Surg Obes Relat Dis. 2009;5(1):81–6.CrossRefPubMed
57.
Hansen EP, Metzsche C, Henningsen E, Toft P. Severe scurvy after gastric bypass surgery and a poor postoperative diet. J Clin Med Res. 2012;4(2):135–7.PubMedPubMedCentral
58.
Conrad ME, Cortell S, Williams HL, Foy AL. Polymerization and intraluminal factors in the absorption of hemoglobin-iron. J Lab Clin Med. 1966;68(4):659–68.PubMed
59.
60.
van den Berghe PV, Klomp LW. New developments in the regulation of intestinal copper absorption. Nutr Rev. 2009;67(11):658–72.CrossRefPubMed
61.
Kumar P, Hamza N, Madhok B, De Alwis N, Sharma M, Miras AD, et al. Copper deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2016;26(6):1335–42.CrossRefPubMed
62.
Livingstone C. Zinc: physiology, deficiency, and parenteral nutrition. Nutr Clin Pract. 2015;30(3):371–82.CrossRefPubMed
63.
Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Basfi-fer K, et al. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. Am J Clin Nutr. 2011;94(4):1004–11.CrossRefPubMed
64.
Jin J, Robinson AV, Hallowell PT, Jasper JJ, Stellato TA, Wilhem SM. Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery. 2007;142(6):914–20. discussion 914–920CrossRefPubMed
65.
Youssef Y, Richards WO, Sekhar N, Kaiser J, Spagnoli A, Abumrad N, et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc. 2007;21(8):1393–6.CrossRefPubMed
66.
Aarts E, van Groningen L, Horst R, Telting D, van Sorge A, Janssen I, et al. Vitamin D absorption: consequences of gastric bypass surgery. Eur J Endocrinol. 2011;164(5):827–32.CrossRefPubMed
67.
Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int. 2015;87(4):839–45.CrossRefPubMed
68.
Kumar R, Lieske JC, Collazo-Clavell ML, Sarr MG, Olson ER, Vrtiska TJ, et al. Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery. Surgery. 2011;149(5):654–61.CrossRefPubMedPubMedCentral
69.
Semins MJ, Matlaga BR, Shore AD, Steele K, Magnuson T, Johns R, et al. The effect of gastric banding on kidney stone disease. Urology. 2009;74(4):746–9.CrossRefPubMedPubMedCentral
70.
Switzer NJ, Marcil G, Prasad S, Debru E, Church N, Mitchell P, et al. Long-term hypovitaminosis D and secondary hyperparathyroidism outcomes of the Roux-en-Y gastric bypass: a systematic review. Obes Rev. 2017;
71.
Alfonso B, Jacobson AS, Alon EE, Via MA. Previous gastric bypass surgery complicating total thyroidectomy. Ear Nose Throat J. 2015;94(3):E12–6.PubMed
72.
Chen Y, Lubitz CC, Shikora SA, Hodin RA, Gaz RD, Moore FD Jr, et al. Primary hyperparathyroidism after Roux-en-Y gastric bypass. Obes Surg. 2015;25(4):700–4.CrossRefPubMed
73.
Hatizifotis M, Dolan K, Newbury L, Fielding G. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes Surg. 2003;13(4):655–7.CrossRefPubMed
74.
Espe KM, Raila J, Henze A, Krane V, Schweigert FJ, Hocher B, et al. Impact of vitamin A on clinical outcomes in haemodialysis patients. Nephrol Dial Transplant. 2011;26(12):4054–61.CrossRefPubMed
75.
Kappus H, Diplock AT. Tolerance and safety of vitamin E: a toxicological position report. Free Radic Biol Med. 1992;13(1):55–74.CrossRefPubMed
76.
Homan J, Ruinemans-Koerts J, Aarts EO, Janssen IM, Berends FJ, de Boer H. Management of vitamin K deficiency after biliopancreatic diversion with or without duodenal switch. Surg Obes Relat Dis. 2016;12(2):338–44.CrossRefPubMed
77.
Norholk LM, Holst JJ, Jeppesen PB. Treatment of adult short bowel syndrome patients with teduglutide. Expert Opin Pharmacother. 2012;13(2):235–43.CrossRefPubMed
78.
Somerville V, Bringans C, Braakhuis A. Polyphenols and Performance: A Systematic Review and Meta-Analysis. Sports Med. 2017;
Metadata
Title
Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update
Authors
Michael A. Via
Jeffrey I. Mechanick
Publication date
01-09-2017
Publisher
Springer US
Published in
Current Obesity Reports / Issue 3/2017
Electronic ISSN: 2162-4968
DOI
https://doi.org/10.1007/s13679-017-0271-x

Other articles of this Issue 3/2017

Current Obesity Reports 3/2017 Go to the issue

The Obesity Epidemic: Causes and Consequences (A Cameron and K Backholer, Section Editors)

The Influence of Fathers on Children’s Physical Activity and Dietary Behaviors: Insights, Recommendations and Future Directions

Health Services and Programs (R Welbourn, Section Editor)

Evidence Base for Multidisciplinary Care of Pediatric/Adolescent Bariatric Surgery Patients

Health Services and Programs (R Welbourn, Section Editor)

Shifts in Food Preferences After Bariatric Surgery: Observational Reports and Proposed Mechanisms

Erratum

Erratum to: Screen Time, Other Sedentary Behaviours, and Obesity Risk in Adults: a Review of Reviews

Psychological Issues (M Hetherington and V Drapeau, Section Editors)

Weight Loss and Appetite Control in Women

Health Services and Programs (R Welbourn, Section Editor)

Potential Hormone Mechanisms of Bariatric Surgery

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits