7 Bariatric Surgery on Micronutrients Flashcards
Obesity
causes pro-imflamatory state
calculated using BMI (kg) / height (m)2
>30kg/m2
central obesity more detrimental - added stress on vital organs
Better method to calculate obesity
waist circumfurance WS
Co-morbidities
obesity with addition of associated diseases
- CVD, type II diabetis etc
Bariatric surgery requirements
> 18 years old
40 BMI
- >35 BMI with serious co-morbidities
- Absence of: eating disorder, major psychiatric diagnosis, tabaco or controlled substance use
- Failure of non-surgical weight loss attempts
Bariatric
branch of medicine focused on cause, prevention and treatment of obesity
Post-surgery complications
vomiting leaking hernia infection macro/micro deficiencies
Bariatric surgery notes (goals and effects)
reduce food/energy intake
gastric capacity reduced by up to 95%
compromises digestion and absorption of nutrients
- bypass nutrient absorption sites in small intestine
reduce weight 35-65%
resolve co-morbities
3 types of Bariatric surgery
Restrictive - reduce stomach capacity - promote satiety Malabsorption - change stomach/small intestine anatomy - change digestion and absorption of nutrients Combined** (most common) - stomach restriction and change small intestine anatomy
Most common restrictive bariatric surgery
adjustable gastric banding (AGB)
Most common ‘malabsorptive’ bariatric surgery
Jejunoileal bypass surgery (JIB)
Most common ‘restrictive and malabsorptive’ bariatric surgery
Roux-en-Y gastric bypass (RYGP)
Key micronutrient issues with bariatric surgery
iron b12 folate thiamin D and calcium
due to decreased intake and absorption
- poor compliance to supplements
Most common micronutrient issue post-surgery? reason?
Iron
- 60% within months
- Women are the majority who have the surgery (menstartion - already an iron issue)
- low heme iron intake b/c poor meat tolerance
- bypass absorption sites (duodenum jejunum)
- reduced HCl in stomach; can’t reduce Ferric iron Fe3+ to ferrous iron Fe2+
- low compliance to supplements
B12 bariatric surgery
reduced gastric acid to cleave B12 from animal protein
decreased intrinsic factor IF
limited meat intake - poor tolerance
- respond well to supplementation
Folate bariatric surgery
less common that b12
poor intake
absorption is ok
can supplement
Thiamin bariatric surgery
encephalopathy (general term disease of the brain)
-confusion, disorientation, brain damage…
alcoholics wernicke-korsakoff syndrome
excessive vomiting
Vit D and Calcium bariatric surgery
most already Vitamin D deficient
- worsens post surgery
- milk least tolerated post surgery
causes calcium problem
-calcium citrate supplemented b/c doesn’t require acid for absorption
Fat soluble vitamins bariatric surgry
fat malabsorption
- from delay mixing with digestive enzymes and bile salts
E not common
A and K deficiencies reported
D big problem
Micronutrients rarely an issue
riboflavin, vit B6, C and E
Minerals bariatric surgry
Zinc and Copper supplemented
