Skip to main content

Advertisement

SpringerLink
Log in

Nutrition Support in Bariatric Surgery

  • Nutrition, Metabolism, and Surgery (KR Miller, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Bariatric surgery is considered to be a safe and effective treatment for patients with obesity (BMI >30) and significant comorbidities. The research is promising for successful long-term weight loss, improvement in coexisting medical conditions, improved functional status and quality of life as well as reduced healthcare costs. There is great responsibility on the part of the patient and their medical providers to ensure these successful outcomes. Different bariatric procedures that include restrictive, malabsorptive, or both mechanisms for weight loss may contribute to altered metabolic complications and nutritional deficiencies. In addition, morbid obesity is associated with a high prevalence of micronutrient deficiency. Adequate pre- and postoperative assessment, nutrition intervention and education, and monitoring are essential to prevent potential problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wolfe BM, Belle SH. Long-term risks and benefits of bariatric surgery: a research challenge. JAMA. 2014;312(17):1792–3.

    Article  CAS  PubMed  Google Scholar 

  2. Piche ME, Auclair A, Harvey J, Marceau S, Poirier P. How to choose and use bariatric surgery in 2015. Can J Cardiol. 2015;31(2):153–66.

    Article  PubMed  Google Scholar 

  3. Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, King WC, Wahed AS, Berk P, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  Google Scholar 

  4. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190, 215–357, iii–iv.

  5. Bonner GL, Nagy AJ, Jupiter DC, Rodriguez JA, Symmonds RE Jr, Carpenter RO. A comparison of postoperative effects of bariatric surgery on medical markers of morbidity. Am J Surg. 2014;208(6):897–902 discussion 1–2.

    Article  PubMed  Google Scholar 

  6. Spaniolas K, Kasten KR, Brinkley J, Sippey ME, Mozer A, Chapman WH, et al. The changing bariatric surgery landscape in the USA. Obes Surg. 2015;25(8):1544–6.

    Article  PubMed  Google Scholar 

  7. •• Manning S, Pucci A, Batterham RL. Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest. 2015;125(3):939–48. This reference reviews the various bariatric procedures and the mechanisms of weight loss involved. It is the most comprehensive and up to date review on mechanisms, bringing together the science with the procedure background. This article also discusses the key drivers in sustained postoperative weight loss.

  8. • Stein J, Stier C, Raab H, Weiner R. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609. This reference is a thorough review of the bariatric procedure related changes in nutrient consumption, absorption and drug bioavailability. The authors provide evidenced based recommendations for nutritional lab monitoring and vitamin/mineral supplementation. In addition, they review the physiological impact in terms of drug absorption as it relates to the anatomical alterations of each surgery.

  9. Martindale RGDC, Bubenik S, Desai S. Metabolic and anatomic complications following bariatric surgery. In: Moore LJ, Turner K, Todd SR, editors. Common problems in acute care surgery. New York: Springer; 2013. p. 413–20.

    Chapter  Google Scholar 

  10. • Lefebvre P, Letois F, Sultan A, Nocca D, Mura T, Galtier F. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6. This reference reviews the preoperative nutritional assessment and deficiencies in the patients who are candidates for bariatric surgery. This evaluation reported 67% of outpatients considering bariatric surgery had a least one major micronutrient deficiency, 6% having 4 deficiencies. The authors make some well-founded recommendations for correction of deficiency prior to surgery.

  11. van Rutte PW, Aarts EO, Smulders JF, Nienhuijs SW. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.

    Article  PubMed  Google Scholar 

  12. Iglar PJ, Hogan KJ. Vitamin D status and surgical outcomes: a systematic review. Patient Saf Surg. 2015;9:14.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Beebe ML, Crowley N. Can hypocaloric, high-protein nutrition support be used in complicated bariatric patients to promote weight loss? Nutr Clin Pract. 2015;30(4):522–9.

    Article  PubMed  Google Scholar 

  14. Sarker A, Meek CL, Park A. Biochemical consequences of bariatric surgery for extreme clinical obesity. Ann Clin Biochem. 2015. doi:10.1177/0004563215588116.

    PubMed  Google Scholar 

  15. Santarpia L, Grandone I, Alfonsi L, Sodo M, Contaldo F, Pasanisi F. Long-term medical complications after malabsorptive procedures: effects of a late clinical nutritional intervention. Nutrition. 2014;30(11–12):1301–5.

    Article  PubMed  Google Scholar 

  16. Salgado W Jr, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014;10(1):49–54.

    Article  PubMed  Google Scholar 

  17. Khanbhai M, Dubb S, Patel K, Ahmed A, Richards T. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery. Obes Res Clin Pract. 2015;9(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  18. van der Beek ES, Monpellier VM, Eland I, Tromp E, van Ramshorst B. Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for post-operative surveillance. Obes Surg. 2015;25(5):818–23.

    Article  PubMed  Google Scholar 

  19. Johansson K, Stephansson O, Neovius M. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(23):2267.

    CAS  PubMed  Google Scholar 

  20. Handzlik-Orlik G, Holecki M, Orlik B, Wylezol M, Dulawa J. Nutrition management of the post-bariatric surgery patient. Nutr Clin Pract. 2015;30(3):383–92.

    Article  PubMed  Google Scholar 

  21. Berger JR, Singhal D. The neurologic complications of bariatric surgery. Handb Clin Neurol. 2014;120:587–94.

    Article  PubMed  Google Scholar 

  22. Saltzman E, Karl JP. Nutrient deficiencies after gastric bypass surgery. Annu Rev Nutr. 2013;33:183–203.

    Article  CAS  PubMed  Google Scholar 

  23. Landais A. Neurological complications of bariatric surgery. Obes Surg. 2014;24(10):1800–7.

    Article  PubMed  Google Scholar 

  24. Cole AJ, Beckman LM, Earthman CP. Vitamin D status following bariatric surgery: implications and recommendations. Nutr Clin Pract. 2014;29(6):751–8.

    Article  CAS  PubMed  Google Scholar 

  25. Costa TL, Paganotto M, Radominski RB, Kulak CM, Borba VC. Calcium metabolism, vitamin D and bone mineral density after bariatric surgery. Osteoporos Int. 2015;26(2):757–64.

    Article  CAS  PubMed  Google Scholar 

  26. Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.

    Article  CAS  PubMed  Google Scholar 

  27. Ballesteros-Pomar MD, Gonzalez de Francisco T, Urioste-Fondo A, Gonzalez-Herraez L, Calleja-Fernandez A, Vidal-Casariego A, et al. Biliopancreatic diversion for severe obesity: long-term effectiveness and nutritional complications. Obes Surg. 2015. doi:10.1007/s11695-015-1719-2.

    Google Scholar 

  28. Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, 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. Surg Obes Relat Dis. 2013;9(2):159–91.

    Article  PubMed  Google Scholar 

  29. Damms-Machado A, Friedrich A, Kramer KM, Stingel K, Meile T, Kuper MA, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR, 97239, USA

    Robert G. Martindale

  2. Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA

    Malissa Warren

  3. Department of Trauma, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L611, Portland, OR, 97239, USA

    Laszlo Kiraly

Authors
  1. Robert G. Martindale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malissa Warren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laszlo Kiraly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert G. Martindale.

Additional information

This article is part of the Topical Collection on Nutrition, Metabolism, and Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martindale, R.G., Warren, M. & Kiraly, L. Nutrition Support in Bariatric Surgery. Curr Surg Rep 3, 30 (2015). https://doi.org/10.1007/s40137-015-0108-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-015-0108-z

Keywords

Search

Navigation