7 Bariatric Surgery on Micronutrients

Question 1

Obesity

Answer 1

causes pro-imflamatory state
calculated using BMI (kg) / height (m)2
>30kg/m2

central obesity more detrimental - added stress on vital organs

Question 2

Better method to calculate obesity

Answer 2

waist circumfurance WS

Question 3

Co-morbidities

Answer 3

obesity with addition of associated diseases

- CVD, type II diabetis etc

Question 4

Bariatric surgery requirements

Answer 4

> 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

Question 5

Bariatric

Answer 5

branch of medicine focused on cause, prevention and treatment of obesity

Question 6

Post-surgery complications

Answer 6

vomiting
leaking
hernia
infection
macro/micro deficiencies

Question 7

Bariatric surgery notes (goals and effects)

Answer 7

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

Question 8

3 types of Bariatric surgery

Answer 8

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

Question 9

Most common restrictive bariatric surgery

Answer 9

adjustable gastric banding (AGB)

Question 10

Most common ‘malabsorptive’ bariatric surgery

Answer 10

Jejunoileal bypass surgery (JIB)

Question 11

Most common ‘restrictive and malabsorptive’ bariatric surgery

Answer 11

Roux-en-Y gastric bypass (RYGP)

Question 12

Key micronutrient issues with bariatric surgery

Answer 12

iron
b12
folate
thiamin
D and calcium

due to decreased intake and absorption
- poor compliance to supplements

Question 13

Most common micronutrient issue post-surgery? reason?

Answer 13

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

Question 14

B12 bariatric surgery

Answer 14

reduced gastric acid to cleave B12 from animal protein
decreased intrinsic factor IF
limited meat intake - poor tolerance

• respond well to supplementation

Question 15

Folate bariatric surgery

Answer 15

less common that b12
poor intake
absorption is ok
can supplement

Question 16

Thiamin bariatric surgery

Answer 16

encephalopathy (general term disease of the brain)
-confusion, disorientation, brain damage…

alcoholics wernicke-korsakoff syndrome
excessive vomiting

Question 17

Vit D and Calcium bariatric surgery

Answer 17

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

Question 18

Fat soluble vitamins bariatric surgry

Answer 18

fat malabsorption
- from delay mixing with digestive enzymes and bile salts

E not common
A and K deficiencies reported
D big problem

Question 19

Micronutrients rarely an issue

Answer 19

riboflavin, vit B6, C and E

Question 20

Minerals bariatric surgry

Answer 20

Zinc and Copper supplemented