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International Journal of Nutrology
Articles
DOI: 10.1055/s-0040-1705668
Submitted: 02-03-2022
Published: 02-03-2022

Revisão das principais deficiências de micronutrientes no pós-operatório do Bypass Gástrico em Y de Roux

Trabalho de conclusão do X Curso Nacional de Nutrologia
bariatric surgery nutritional deficiencies micronutrient deficiencies nutritional complications

Abstract

Introduction: Obesity is a chronic disorder that is increasing worldwide. Nowadays, bariatric surgery is the only effective treatment for morbid obesity that consistently achieves and maintains a sustained weight loss, decreases the incidence and severity of obesity-related comorbidities, and improves overall quality of life and survival. The United States is the champion in number of surgeries performed, followed by Brazil. Roux-en-Y gastric bypass (RYGB) is a safe and effective technique of bariatric surgery, comprising about 70 to 75% of all bariatric procedures worldwide. Objectives: Address key nutritional deficiencies in the population subjected to RYGB and its clinical consequences. Methods: Literature review of articles published in the past decade related to major nutritional deficiencies observed postoperatively in RYGB. Results: Approximately 30% of bariatric surgery patients will develop a macro and / or micronutrients deficiences. In the RYGB, the major nutritional complications of micronutrients includes iron, calcium, folic acid and vitamin B12. In cases where there is presence of a very long-limb, patients have increased risk of deficiency of fat- soluble vitamins (A, D, E, K), essential fatty acids, copper and zinc. Conclusion: All bariatric surgery patients should make vitamins and minerals supplementation on a daily basis. There is still no consensus on the dose needed to avoid such deficiencies. Some complications arise micronutrient months postoperatively, while others may occur even years after bariatric surgery. Therefore, there is a need for clinical and nutritional status of patients and monitoring of possible nutritional deficiencies for life.

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References

  1. AILLS L, Blankenship J, et al. Allied Health Nutritional Guidelines for the Surgical Weight Loss Pacient. Surg Obes Relat Dis, Suppl. 5, p. S73-108, 2008.
  2. ALVAREZ-LEITE JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care, 7, p. 569-75, 2004.
  3. AMMOR N, Berthoud L, Gerber A, Giusti V. Nutritional deficiencies in candidates for bariatric surgery. Rev Med Suisse, 5, p. 676–9, 2009.
  4. ASHEIM ET. Wernicke encephalopathy after bariatric surgaery: a systematic review. Ann Surg., 248, p. 714-20, 2008.
  5. ASMBS. Bariatric surgery fact sheet. American Society for Metabolic and Bariatric Surgery. 2011.
  6. BUCHWALD H. Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes, 1, p. 371-81, 2005.
  7. BERNERT CP, Ciangura C, Coupaye M, Czernichow S, Bouillot JL, Basdevant A. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab., 33, p. 13–24, 2007.
  8. BLOOMBERG RD, Fleishman A, Nalle JE et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg., 15, p. 145-54, 2000.
  9. BOYLAN L, Sugerman H, Driskkel J. Vitamin E, vitamin B6, vitamin B12 and folate status of gastric bypass surgery patients. J Am Diet Ass., 88, p. 579-85, 1988.
  10. BORDALO L et al. Deficiências nutricionais após cirurgia bariátrica. Acta Med Port. 24(S4), p. 1021-1028, 2011.
  11. BROLIN RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass for morbid obesity. Obese Surg., 9, p. 150-4, 1999.
  12. BUCHWALD H. Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes, 1, p. 371-81, 2005.
  13. CHANG CG, Adams-Hurst B, Provost DA. Acute post gastric reduction surgery (APGARS) neuropathy. Obes Surg., 14, p. 182-9, 2004.
  14. CLEMENTS RH, Katasani VG, Palepu R, Leeth RR, Leath TD, Roy BP, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg., 72, p. 1196–204, 2006.
  15. COATES PS, Fernstrom JD, Fernstrom MH et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab., 89, p. 1061-5, 2004.
  16. DAVIES DJ, Baxter JM et al. Nutritional deficiencies after bariatric surgery. Obesity surgery, 17, p. 1150-58, 2007.
  17. DINIZ M de F, Diniz MT, Sanches SR, Salgado PP, Valadão MM, Araújo FC, et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg., 14, p.1222–6, 2004.
  18. DIXON JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after lap-band surgery: higher folate and vitamin B12 levels required to maintain homocysteine levels. Int J Obes Relat Metab Disord., 2, p. 219-27, 2001.
  19. FLEGAL KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults 1999-2002, JAMA, 288, p. 1723, 2004.
  20. FUJIOKA K, DiBiase JK, Martindale RG. Nutrition and metabolic omplications after bariatric surgery and their treatment. JPEN J Parenter Enteral Nutr, Vol. 35, Supll. 1, p. 35-52S, 28 July 2011.
  21. GASTEYGER C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr, 87, p. 1128–33, 2008.
  22. GEHER S, Kern B, Peters T. Fewer nutrient after laparoscopic sleeve gastrectomy than after Roux-en-Y gastric bypass – a prospective study. Obes Surg., 20, p. 447-53, 2010.
  23. HATIZIFOTIS M, Dolan K, Newbury L, Fielding G. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes Surg,13, p.655–7, 2003.
  24. HAVERSTON JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg., 52, p. 594-8, 1986.
  25. HOT T. Long term results after laparoscopic Roux-en-Y gastric bypass: 10 year follow up. Surg Obes., 5, p. 211, 2009.
  26. JUHASZ-POCSINE K, Rudnicki SA, Archer RL, Harik SI. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology, 68, p.1843–50, 2007.
  27. KHAZAI N, Judds S et al. Calcium and vitamin D: Skeletal and extraskeletal health. Cur Rheumatol Reports., 10, p. 110-17, 2008.
  28. KUSHNER R. Managing the obese after bariatric surgery: a case report of severe malnutrition and review of the literature. JPEN J Parent Enteral Nutr., 24, p. 126-32, 2000.
  29. LEE WB, Hamilton SM, Harris JP, Schwab IR. Ocular complications of hypovitaminosis after bariatric surgery. Ophthalmology., 112, p.1031–4, 2005.
  30. LOH Y, Watson WD, Verma A, Chang ST, Stocker DJ, Labutta RJ. Acute Wernicke's encephalopathy following bariatric surgery: Clinical course and MRI correlation. Obes Surg., 14, p. 129–32, 2004.
  31. MALINOWSKI SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci, 331, p. 219-25, 2006.
  32. MALONE M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmocother, 42, p. 1851–8, 2008.
  33. MARCUAD SP, Sinar DR, Swanson MS et al. Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. Dig Dis Sci., 34, p. 238-42, 1989.
  34. MARINELLA MA. Anemia following Roux-en-Y surgery for morbid obesity: Areview. South Med J, 101, p. 1024–31, 2008.
  35. McMAHON MM, Sarr MG, Clark MM, et al. Clinical management after bariatric surgery: value of a multidisciplinary approach. Mayo Clin Proc., Suppl 81, p. S34-S45, 2006.
  36. MECHANICK JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery medical guideline for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity, 17, p. 1-70, 2009.
  37. MIZON C, Ruz M, Csendes A, Carrasco F, Rebolledo A, Codoceo J, et al. Persistent anemia after Roux-en-Y gastric bypass. Nutrition., 23, p.277–80 2007.
  38. PADMINI S, Boylan M et al. Micronutrients deficiencies after bariatric surgery. Nutrition, 2010.
  39. PEREIRA SE, Sabova CJ, Chaves GV, Ramalho A. Class III obesity and its relationship with the nutritional status of vitamin A in pre- and postoperative gastric bypass. Obes Surg., 19, p.738–44, 2009.
  40. PRODAN CI, Bottomley SS, Vincent AS, Cowan LD, Meerveld BG, Holland NR, et al. Copper deficiency after gastric surgery: A reason for caution. Am J Med Sci, 337, p.256–8, 2009.
  41. SALAS-SALVADO J, Garcia-Lorda P, Cuatrecasas G, et al. Wernicke's syndrome after bariatric surgery. Clin Nutr., 19, p. 371-373, 2000.
  42. SECHI G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol., 6, p. 442-55, 2007.
  43. SJOSTROM L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. NEngl J Med, 351, p. 2683-2693, 2004.
  44. SKROUBIS G, Sakellaropoulos G, Pouggouras K et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion after Roux-en-Y gastric bypass. Obes Surg., 12, p. 551-8, 2002.
  45. SLATER GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg., 8, p.48–55, 2004.
  46. SMITH BR, Schauer P, Nguyen NT. Surgical approaches to treatment of obesity: bariatric surgery. Endocrinolog Metab Clin North Am, 37, p. 943-64, 2008.
  47. STURM R. Increases in morbid obesity in the USA: 2000–2005. Public Health, 121, p. 492–6, 2007.
  48. TONDAPU P, Provost D, Adams-Huet B, Sims T, Chang C, Sakhaee K. Comparison of the absorption of calcium carbonate and calcium citrate after Roux-en-Y gastric bypass. Obes Surg., 19, p. 1256–61, 2009.

How to Cite

Torezan, E. F. G. (2022). Revisão das principais deficiências de micronutrientes no pós-operatório do Bypass Gástrico em Y de Roux. International Journal of Nutrology, 6(1), 37–42. https://doi.org/10.1055/s-0040-1705668