Nutrition and Metabolic Support Recommendations for the Bariatric Patient

Abstract

Managing the metabolic needs of the patient with obesity is a challenge unto itself without the added demands of accounting for an altered gastrointestinal tract. Nevertheless, with about 200,000 bariatric procedures being performed annually in the United States, clinicians must be prepared to manage the critically ill bariatric surgery patient. This article reviews the recent literature relating to nutrient needs and metabolic support for the bariatric patient. Bariatric patients are at risk for several micronutrient deficiencies, including vitamins D and B₁₂, calcium, and iron; some bariatric procedures affect macronutrient needs as well. Literature on nutrition support guidelines for the bariatric population is limited. However, with an understanding of the anatomical and physiological effects of bariatric surgery, recent guidelines for critically ill patients with obesity can be applied to the bariatric surgery population. The unique needs of the bariatric population, such as susceptibility to micronutrient deficiencies and specialized access routes, must be considered to provide safe and efficacious nutrition support. Further research is necessary to develop specific nutrition support recommendations for the bariatric population.

Changes in Home Parenteral Nutrition Practice Based on the Canadian Home Parenteral Nutrition Patient Registry

“…Copper toxicity is rare and may cause liver cirrhosis 26 . However, copper deficiency produces hypochromic, microcytic anemia, neutropenia, and neurologic dysfunction in the form of myelopathy 27 , 28…”

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

“…Figure 1 represents the flow diagram for CPGs selection. Although several papers have discussed recommendations on nutritional supplements replacement following bariatric surgery [18-20], we identified only three eligible CPGs developed by the following organizations (Table 1):…”

Can Hypocaloric, High‐Protein Nutrition Support Be Used in Complicated Bariatric Patients to Promote Weight Loss?

“…Standard weekly laboratory monitoring for home PN patients includes a weekly electrolyte panel and complete blood count with differential and monthly monitoring of liver enzymes, triglycerides, and serum proteins. Once stable, electrolyte and complete blood count panel monitoring can be decreased to monthly 42 . Vitamin and mineral levels, including iron, copper, zinc, selenium, thiamine, folate, vitamin B 12 , and vitamin D, should be checked at least every 6 months 25 , 43 .…”

“…Baseline laboratory values should be obtained when starting nutrition support and appropriate supplementation provided as needed 41 . Recommendations for supplementation and monitoring of micronutrient deficiencies are available in several recent publications 42 , 44 , 45 . Glucose levels should also be monitored closely at the beginning of therapy to avoid hyperglycemia, although the risk of hyperglycemia may be lower in hypocaloric feedings compared with eucaloric feedings 28 …”