Nutritional considerations for plastic surgery in post-bariatric surgery patients

NIRUJOGI, VIJAYA LAKSHMI; ZOPFI, KELLY

doi:10.5935/2177-1235.2015RBCP0158

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Cirurgia Plástica

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. Bras. Cir. Plást. 30 (2) • Apr-Jun 2015 • https://doi.org/10.5935/2177-1235.2015RBCP0158 copy

Nutritional considerations for plastic surgery in post-bariatric surgery patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Bariatric surgery continues to be the most effective treatment for morbid obesity and most other associated metabolic conditions such as type 2 diabetes mellitus, gastroesophageal reflux disease, and obstructive sleep apnea. In the obese population, common nutritional deficiencies include vitamins A, C, D, and B12, folate, thiamine, iron, ferritin, zinc, and selenium. With massive weight loss, many patients may utilize body contouring for deformities. After massive weight loss following bariatric surgery, patients often develop significant nutritional deficiencies that increase the risk of postoperative morbidity and mortality with any subsequent surgeries. Some unique patients will require additional evaluation during illness or when considering elective surgery due to alterations to the alimentary tract, in order to optimize outcomes and prevent complications from nutritional deficiencies.

Keywords:
Nutrition; Deficiency diseases; Bariatric surgery; Drug-Related side effects and Adverse reactions.

	Laboratory Test	Obese non-BS	AGB/SG	RYGB	Distal RYGB	BPD-DS
Hemoglobin (RBC indices)	CBC w/auto differential			occasional	occasional	occasional
Protein	serum albumin			less common	common	common
	serum protein			early
Iron (elemental)	serum iron serum Ferritin TIBC/%saturation	rare to occasional		common	common	common
Vitamin D		quite common		common	common	common
Vitamin A	plasma retinol	rare			rare	quite common
Vitamin E	Plasma alpha tocopherol	rare				uncommon
Vitamin C		fairly common		fairly common
Vitamin K	PT (INR)	rare	^*depleted with emesis with a slipped AGB			quite common
B1 (Thiamine)	transketolase	occasional (Caucasian) fairly common (African Americans & Hispanics)	w/emesis	occasional
B2 (Riboflavin)		occasional		rare	rare
B6 (Pyridoxine)	Pyridoxal-5'-phophate	occasional		occasional
B9 (Folate)	RBC folate	occasional		less common	common	common
B 12 (Cobalamin)		occasional		common		common
Zinc	plasma zinc	fairly common		occasional	fairly common	fairly common
Copper	cu				rare	occasional
Selenium				quite common	quite common	quite common
Magnesium		increased risk with long term PPI use; also found with DM.		rare	rare	rare

	AGB	RYGB
Protein 1.5g/kg IBW/day		periodic review by Registered Dietician
Iron, elemental	18 mg/d initially	36 mg/d initially
Vitamin D3 ^ Titrate to 25hydroxyvitamin D level > 40 ng/ml;	800 IU initially	800 IU initially
Vitamin A	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
Vitamin C	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	500 mg/each iron serving
Vitamin K	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
Thiamine (B1)	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%; more if emesis or EtoH use (100 mg/d)
folate (B9)	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
cobalamin (B12)^* ***** goal > 250 mg/nl; increased risk with long term PPI use & and with dx of DM; low Mg may increase risk of constipation. # sufficient doses to suppress parathyroid hormone, may need 50,000 units 1-3 times weekly; up to 6000 IU daily after normalization; AGB: Adjustable gastric band; RYGB: Roux-en-Y gastric bypass; PPI: Proton pump inhibitor; DM: Diabetes mellitus; ASMBS: American Society for Metabolic and Bariatric Surgery.	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	1000 mcg 1-3 x /week sublingual
Zinc	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
Copper	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
Selenium	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;
Magnesium	^* * Multi-vitamin should contain; calcium citrate better absorbed: split into 500-600 mg doses; Iron: Avoid taking with dairy or tannins (coffee, tea), Vitamin C aids absorption; may require 100-300 mg/d in menstruating women. Titrate to iron saturation 30-40%;	400 mg/d
Calcium, elemental	1200-1500 mg/d	1500-2000 mg/d
MultiVitamin	100% daily value	200% daily value
B complex	#	encourage B 50-100 complex
Probiotics, daily		for treatment of bowel irregularity

	AGB	RYGB
Protein 1.5 g/kg IBW/day Iron, elemental	18 mg/d initially	36 mg/d initially
Vitamin D3 ^ Titrate to 25hydroxyvitamin D level > 30 ng/ml;	800 IU initially	800 IU initially
Vitamin A	^* * in multivitamin;	^* * in multivitamin;
Vitamin C	^* * in multivitamin;	500 mg/each iron serving
Vitamin K	^* * in multivitamin;	^* * in multivitamin;
Thiamine (B1)	^* * in multivitamin;	^* * in multivitamin; more if emesis (100 mg/d)
folate (B9)	^* * in multivitamin;	^* * in multivitamin;
cobalamin (B12)^* ***** goal > 250 mg/nl; increased risk with long term PPI use & and with dx of DM; low Mg may increase risk of constipation; # sufficient doses to suppress parathyroid hormone, may need 50,000 units 1-3 times weekly; up to 6000 IU daily after normalization; AGB: Adjustable gastric band; RYGB: Roux-en-Y gastric bypass; PPI: Proton pump inhibitor; DM: Diabetes mellitus; ASMBS: American Society for Metabolic and Bariatric Surgery.	^* * in multivitamin;	350-500 mg orally/d of crystalline
Zinc	^* * in multivitamin;	^* * in multivitamin;
Copper	^* * in multivitamin;	^* * in multivitamin;
Selenium	^* * in multivitamin;	^* * in multivitamin;
Magnesium	^* * in multivitamin;	^* * in multivitamin;
Calcium, elemental	1200-1500 mg/d	1500-2000 mg/d
MultiVitamin	100% daily value	200% daily value
B complex		encouraged

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: Vijaya L. Nirujogi 1000 North Oak Ave, Marshfield, WI, USA 54449. E-mail: nirujogi.vijaya@marshfieldclinic.org