Abstract
Background
Bariatric surgery numbers have seen a sharp rise in India in the last decade. A country known for its undernourished population has seen economic growth and with it, greater influence of western culture and foods. The obesity epidemic is on the rise here and India is one of the 10 most obese nations of the world being second only to China in the number of type 2 diabetes. Nutritionists in India often rely on recommendations and guidelines meant for the Caucasian population. Religious and cultural practices influence the dietary habits and patterns of the Indian population to a great extent; because of which the nutritional requirements are very different. This document was put together with an aim to provide nutritionists with recommendations on how to manage the Indian bariatric patient.
Methods
A bariatric nutrition round table meeting was initiated by the Centre for Obesity and Digestive Surgery (CODS) to bring together experts in the field of bariatric nutrition to review current data on nutritional deficiencies in the morbid obese and existing post-operative deficiencies and to formulate nutritional recommendations for bariatric/metabolic surgery specific to patients from India.
Results
Percentage of nutritional deficiencies and reasons for the same were identified among the Indian population and recommendations were made to suit this particular population.
Conclusion
It is recommended that all patients undergo compulsory pre-operative nutritional counseling and nutritional investigations and that nutritional follow-up be continued lifelong. In addition, long-term implications like hypoglycemia, dumping syndrome, sugar cravings, and weight regain, need to be picked up and managed efficiently. Most importantly, post-operative supplementation is a must irrespective of type of surgery.
This is a preview of subscription content, access via your institution.
References
Seshadri S. Prevalence of micronutrient deficiency particularly of iron, zinc and folic acid in pregnant women in South East Asia. Br J Nutr. 2001;85 Suppl 2:S87–92.
Jain M, Sharma S. Iron deficiency and anemia. Indian J Fundam Appl Life Sci. 2012;2(2):101–7.
Panigrahi A, Sahoo PB. Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa. Indian J Public Health. 2011;55(4):317–20.
Rammohan A , Awofeso N , Robitaille MC , 2012, Addressing female iron-deficiency anaemia in India: is vegetarianism the major obstacle?, ISRN Public Health , Article ID 765476, 8 pages
Reddy NR, Sathe SK. Food phytates. Florida: CRC Press; 2001.
Zijp IM, Korver O, Tijburg LBM, et al. Effect of tea and other dietary factors on iron absorption. Crit Rev Food Sci Nutr. 2000;40(5):371–98.
Misra A, Rastogi K, Joshi SR, et al. Whole grains and health: perspective for Asian Indians. J Assoc Physicians India. 2009;57(2):155–62.
Allen LH. To what extent can food-based approaches improve micronutrient status? Asia Pac J Clin Nutr. 2008;17(1):103–5.
Lonnerdal B. Soybean ferritin: implications for iron status of vegetarians. Am J Clin Nutr. 2009;89(5):1680S–5.
Elmadfa I, Singer I. Vitamin B-12 and homocysteine status among vegetarians: a global perspective1–4. Am J Clin Nutr. 2009;89(5):1693S–8.
Yajnik CS, Deshpande SS, Lubree HG, et al. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India. 2006;54:775–82.
Bhatia P, Kulkarni J, Pai S, et al. Vitamin B12 deficiency in India: meancorpuscular volume is an unreliable screening. Natl Med J India. 2012;25(6):336–8.
Gupta AK, Damji A, Uppaluri A, et al. Vitamin B12 deficiency, prevalence among South Asians at a Toronto clinic. Can Fam Physician. 2004;50:743–7.
Antony AC. Vegetarianism and vitamin B-12 (cobalamin) deficiency1–4. Am J Clin Nutr. 2003;78:3–6.
Antony AC. Megaloblasticanemias. In: Hoffman R, Benz Jr EJ, Shattil SJ, et al., editors. Hematology. Basic principles and practice. 3rd ed. New York: Churchill – Livingstone; 2000. p. 446–85.
Wokes F, Badenoch J, Sinclair HM. Human dietary deficiency of vitamin B12. Am J Clin Nutr. 1955;3(5):375–82.
Refsum H, Yajnik CS, Gadkari M, et al. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001;74:233–41.
Goswami R, Mishra SK, Kochupillai N. Prevalence and potential significance of vitamin D deficiency in Asian Indians. Indian J Med Res. 2008;127:229–38.
Harinarayan CV, Joshi SR. Vitamin D status in India—its implications and remedial measures. J Assoc Physicians India. 2009;57:40–8.
Sachan A, Gupta R, Das V, et al. High prevalence of Vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005;81(5):1060–4.
Pettifor JM. Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr. 2004;80(6):1725S–9.
Clements MR. The problem of rickets in UK Asians. J Hum Nutr Diet. 1989;2:105–16.
Goswami R, Gupta N, Goswami D, et al. Prevalence and significance of low 25- hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr. 2000;72(2):472–5.
Bhatia V. Dietary calcium intake—a critical reappraisal. Indian J Med Res. 2008;127:269–73.
Londhey V. Vitamin D deficiency: Indian scenario. J Assoc Physicians India. 2011;59:695–6.
Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Nutrients. 2000;72(3):690–3.
Aills L, Blankenship J, Buffington C, et al. Bariatric nutrition: suggestions for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4:S73–108.
Ozkan B, Hatun S, Bereket A. Vitamin D intoxication. Turk J Pediatr. 2012;54(2):93–8.
Harnaraya CV, Ramalakshmi T, Prasad UV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr. 2007;85(4):1062–7.
Harinarayan CV, Ramalakshmi T, Venkataprasad U. High prevalence of low dietary calcium and low vitamin D status in healthy south Indians. Asia Pac J Clin Nutr. 2004;13(4):359–64.
Teotia SPS, Teotia M. Nutritional bone disease in Indian population. Indian J Med Res. 2008;127:219–28.
Sakhaee K, Bhuket T, Adams-Huet B, et al. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther. 1999;6(6):313–21.
Curhan GC, Willet WC, Speizer FE, et al. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Int Med. 1997;126(7):497–504.
Mc Lean E, De Boist B, Allen LH. Review of the magnitude of Folate and Vit B12 deficiencies worldwide. Food Nutr Bull. 2008;29(2):S38–51.
Cherian A, Seena S, Bullock RK, et al. Incidence of neural tube defects in the least-developed area of India: a population-based study. Lancet. 2005;366(9489):930–1.
Rao SN, Mani S, Madap K, et al. High prevalence of infantile encephalitic beriberi with overlapping features of Leigh’s disease. J Trop Pediatr. 2008;54(5):328–32.
World Health Organization. Thiamine deficiency and its prevention and control in major emergencies Geneva, Switzerland: Department of Nutrition for Health and Development, World Health Organization, 1999 (WHO/NHD/99.13).
Raziel A. Thiamine deficiency after bariatric surgery may lead to wernicke encephalopathy. Isr Med Assoc J. 2012;14:692–3.
Kapil U, Jain K. Magnitude of zinc deficiency amongst under five children in India. Indian J Pediatr. 2011;78(9):1069–72.
Dhingra U, Hiremath G, Menon VP, et al. Zinc deficiency: descriptive epidemiology and morbidity among preschool children in peri-urban population in Delhi. India J Health Popul Nutr. 2009;27(5):632–9.
Madan AK, Orth WS, Tichansky DS, et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16:603–6.
Cominetti C, Garrido Jr AB, Cozzolino SM. Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report. Obes Surg. 2006;16:448–53.
Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press; 2001.
Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol. 2006;20:3–18.
Prasad AS. Zinc deficiency: its characterization and treatment. Met Ions Biol Syst. 2004;41:103–37.
Wang LC, Busbey S. Acquired acrodermatitis enteropathica. N Engl J Med. 2005;352:1121.
Pathak P, Kapoor SK, Kapil U, et al. Copper nutriture amongst pregnant women in a rural area of India. East J Med. 2003;8:15–7.
Kapil U, Singh P. Serum copper levels among a tribal population in Jharkhand State, India: a pilot survey. Food Nutr Bull. 2005;26(3):309–11.
Beshgetoor D, Hambidge M. Clinical conditions altering copper metabolism in humans. Am J Clin Nutr. 1998;67:1017S–21.
Griffith DP, Liff D, Ziegler T, et al. Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity. 2009;17(4):827–31.
Ernst B, Thurnheer M, Schultes B. Copper deficiency after gastric bypass surgery. Obesity (Silver Spring). 2009;17:1980–1.
Robinson S, Copper B, Leday VK. Copper deficiency (hypocupremia) and pancytopenia late after gastric bypass surgery. Proc (Bayl Univ Med Cent). 2013;26(4):382–6.
Williams DM. Copper deficiency in humans. Semin Hematol. 1983;20(2):118–28.
Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.Washington (DC): National Academies Press (US); 1997. ISBN-10: 0-309-06350-7ISBN-10: 0-309-06403-1 http://www.ncbi.nlm.nih.gov/books/NBK109825/
Dolan K, Hatzifotis M, Newbury L, et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg. 2004;240(1):51–6.
Arlappa N, Balakrishna N, Laxmaiah A, et al. Prevalence of vitamin A deficiency and its determinants among the rural pre-school children of Madhya Pradesh. India Ann Hum Biol. 2011;38(2):131–6.
Arlappa N, Laxmaiah A, Balakrishna N, et al. Clinical and sub-clinical vitamin A deficiency among rural pre-school children of Maharashtra. India Ann Hum Biol. 2008;35(6):606–9.
Kalra V, Grover JK, Ahuja GK, et al. Vitamin E administration and reversal of neurological deficits in protein-energy malnutrition. J Trop Pediatr. 2001;47(1):39–45.
WHO. Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO global database on vitamin A deficiency. Geneva: World Health Organization; 2009.
Conflict of Interest
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
• Dr. Cynthia Buffington
PhD, from The Metabolic Medicine and Surgery Institute, Florida Hospital Celebration Health
• Dr. John Dixon
Head of Clinical Research, Centre for Obesity Research and Education and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
• Ms. Wan-Ling Hsu
Nutritionist, Bariatric and Metabolic International Surgery Center, E-Da Hospital, Taiwan
• Ms. Huang, Ya-we
Case manager, Bariatric and Metabolic International Surgery Center, E-Da hospital, Taiwan
• Ms. Carlyne Remedios
Accredited practicing dietician (APD) from Dietitians association of Australia
Senior Nutritionist – Centre For Obesity and Digestive Surgery, Mumbai, India
• Dr. C Anjali Devi
Visiting professor Osmania University, Hyderabad, India
• Dr. Jagmeet Madan
Principal and Professor, Department of Food and Nutrition at SVT College of Home Science, SNDT Women’s University, Mumbai, India
Mumbai President, Indian Dietetics Association, Mumbai Chapter
• Ms. P. Aslesha
Assistant Professor, Department Food Science and Nutrition, Osmania University, Hyderabad, India
• Dr. Poonam Shah
Founder and Director of Laparo-Obeso Centre
Bariatric Physician, Ruby Hall Obesity Clinic, Pune
• Dr. Bhaskarachary
Scientist ‘C’ Division of Molecular Biology, National Institute of Nutrition, Hyderabad, India
National Vice President, Indian Dietetic Association
• Ms. Ritika Sammadar
HOD Dietetics, Max Healthcare, New Delhi
• Dr. Janaki Srinath
Hyderabad President, Indian Dietetics Association, Andhra Pradesh Chapter
Vice President AIAARO (All India Association for Advancing Research in Obesity)
• Ms. Neha Dhulla
Bariatric Nutritionist, Centre for Obesity and Digestive Surgery
• Ms. Shilpa Dhar
Bariatric Nutritionist, Centre for Obesity and Digestive Surgery
Certified Diabetic Educator
Rights and permissions
About this article
Cite this article
Remedios, C., Bhasker, A.G., Dhulla, N. et al. Bariatric Nutrition Guidelines for the Indian Population. OBES SURG 26, 1057–1068 (2016). https://doi.org/10.1007/s11695-015-1836-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-015-1836-y
Keywords
- Bariatric nutrition
- Indian
- Nutritional recommendations
- Supplementation
- Deficiency
- Morbid obesity