7 Bariatric Surgery on Micronutrients Flashcards Preview

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Flashcards in 7 Bariatric Surgery on Micronutrients Deck (20):
1

Obesity

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

central obesity more detrimental - added stress on vital organs

2

Better method to calculate obesity

waist circumfurance WS

3

Co-morbidities

obesity with addition of associated diseases
- CVD, type II diabetis etc

4

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

5

Bariatric

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

6

Post-surgery complications

vomiting
leaking
hernia
infection
macro/micro deficiencies

7

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

8

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

9

Most common restrictive bariatric surgery

adjustable gastric banding (AGB)

10

Most common 'malabsorptive' bariatric surgery

Jejunoileal bypass surgery (JIB)

11

Most common 'restrictive and malabsorptive' bariatric surgery

Roux-en-Y gastric bypass (RYGP)

12

Key micronutrient issues with bariatric surgery

iron
b12
folate
thiamin
D and calcium

due to decreased intake and absorption
- poor compliance to supplements

13

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

14

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

15

Folate bariatric surgery

less common that b12
poor intake
absorption is ok
can supplement

16

Thiamin bariatric surgery

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

alcoholics wernicke-korsakoff syndrome
excessive vomiting

17

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

18

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

19

Micronutrients rarely an issue

riboflavin, vit B6, C and E

20

Minerals bariatric surgry

Zinc and Copper supplemented