1. Nutritional Considerations After Bariatric Surgery
Michelle Lee, PhD, RD, LDN
Assistant Professor-Nutrition
Department of Allied Health
College of Clinical and Rehabilitative Sciences
ETSU

2. Objectives:
What are the short-term nutritional implications for individuals receiving bariatric surgery?
What are the long-term nutritional implications for individuals receiving bariatric surgery?

3. Bariatric Surgery Trends
Between 2003 and 2008, bariatric surgeries peaked in 2004 and has remained steady(1)
Number of weight loss surgeries increased from 103,000 in 2003 to ~220,000 in 2008(2)
Bariatric surgery in NOT a quick fix for morbid obesity
There are nutritional implications for any bariatric surgery

4. Types of Bariatric Surgery
Restrictive
Laparoscopic adjustable gastric band (LAGB)
Vertical banded gastroplasty (VBG)
Intragastric balloon
Malabsorptive
Bilopancreatic diversion with duodenal switch (BPD/DS)
Jejunoileal bypass
Bilopancreatic diversion (BPD)
Primary Restrictive with a Malabsorptive Component
Roux-en-Y gastric bypass (RYGB)

5. Laparoscopic Adjustable Gastric Band

6. Roux-en-Y Gastric Bypass

7. Nutritional Implications of Various Bariatric Surgeries(3,4)
RYGB
Malabsorption of Vit B12, Vit B1 (thiamin), Vit D, Vit K, Folate, Iron, Calcium
LAGB
Folic Acid deficiency
BPD and BPD/DS
Vit A, D, E, and K deficiency, Protein-Calorie Malnutrition, Malabsorption of Calcium, Zinc, Selenium, Sodium, Potassium, Chloride, Phosphorus, Magnesium

8. Sites of Nutrient Absorption(4)
Stomach
Water, ethyl alcohol, copper, iodide, fluoride, molybdemum, intrinsic factor
Duodenum
Calcium, iron, phosphorus, magnesium, copper, selenium, thiamin, riboflavin, niacin, biotin, folate, vitamins A, D, E, K

9. Sites of Nutrient Absorption(4)
Jejunum
Thiamin, riboflavin, niacin, pantothenate, biotin, folate, vit B6, vit C, vit A, D, E, K, dipeptides, tripeptides, calcium, phosphorus, magnesium, iron, zinc, chromium, manganese, molybdenum, amino acids
Ileum
Vit C, folate, vit B12, vit D, vit K, magnesium, bile salts/acids

11. Macronutrient Concerns
Protein
Carbohydrates
Fat

12. Micronutrient Concerns
Iron
Calcium and Vitamin D
Vitamin B12
Folic acid
Thiamin
Zinc

13. Recommended Daily Supplements(4)
Multivitamin with iron (prenatal vitamin will have adeq amount of folic acid)
Calcium (citrate) with vitamin D ( mg calcium with IU vitamin D)
Oral vitamin B12 ( mcg)
Iron (65 mg/day in elemental form)
Vitamin C (to increase absorption of Iron)
Thiamin (10 mg/day)

14. Diet Progression After Bariatric Surgery(5)
Clear Liquids
Full liquids
Pureed food
Mechanical soft food
Soft food
Regular diet

15. Diet Recommendations(3)
Reduce food volume
Chew food very well
Slow pace of eating
No liquids with meals
Encourage fruits and vegetables as diet progresses
Include high protein foods (at least 60g/day); may need protein supplements

16. References
Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery J Am Coll Surg ;213(2):
Weight-Control Information Network. Longitudinal assessment of bariatric surgery (LABS). NIH Publication No Accessed February 25, 2012.
Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of weight-loss surgery. Med Clin N Am. 2007;91:
Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29-40.
Furtado LC. Nutritional management after Roux-en-Y gastric bypass. Br J Nurs. 2010;19(7):

17. Questions