Nutritional Considerations After
Bariatric Surgery
Michelle Lee, PhD, RD, LDN
Assistant Professor-Nutrition
Department of Allied Health
College of Clinical and Rehabilitative Sciences
ETSU
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?
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
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)
Laparoscopic Adjustable Gastric Band
Roux-en-Y Gastric Bypass
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
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
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
Macronutrient Concerns
• Protein
• Carbohydrates
• Fat
Micronutrient Concerns
•
•
•
•
•
•
Iron
Calcium and Vitamin D
Vitamin B12
Folic acid
Thiamin
Zinc
Recommended Daily Supplements(4)
• Multivitamin with iron (prenatal vitamin will
have adeq amount of folic acid)
• Calcium (citrate) with vitamin D (1200-1500 mg
calcium with 800-1000 IU vitamin D)
• Oral vitamin B12 (500-1000 mcg)
• Iron (65 mg/day in elemental form)
▫ Vitamin C (to increase absorption of Iron)
• Thiamin (10 mg/day)
Diet Progression After Bariatric
Surgery(5)
•
•
•
•
•
•
Clear Liquids
Full liquids
Pureed food
Mechanical soft food
Soft food
Regular diet
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
References
1. Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J.
Trends in use of bariatric surgery. 2003-2008. J Am Coll Surg.
2011;213(2):261-266.
2. Weight-Control Information Network. Longitudinal assessment of
bariatric surgery (LABS). NIH Publication No. 04-5573.
http://win.niddk.nih.gov/publications/PDFs/LABS_FactSheet.pdf.
Accessed February 25, 2012.
3. Tucker ON, Szomstein S, Rosenthal RJ. Nutritional consequences of
weight-loss surgery. Med Clin N Am. 2007;91:499-514.
4. Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal
complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29-40.
5. Furtado LC. Nutritional management after Roux-en-Y gastric bypass. Br J
Nurs. 2010;19(7):428-436.
Questions