Midterm 2 (lecture 9) Flashcards
Obesity is a major public health issue
Obesity is a growing epidemic in developed countries
Increases risk of multiple co morbidities
- heart disease, diabetes, hypertension etc
Defined by body mass index calculated as weight (kg)/ height (m)2
- obesity classified as BMI > or equal to 30 kg/m2
Great burden in health care, economics, and many aspects of life
Central obesity is more detrimental to health because of added stress on organs
Bariatric surgery notes
Numerous post surgery complications
- vomiting, leaking, hernia, infection
- risk of micronutrient deficiencies
Reduces food consumption (get full faster) and energy intake
Gastric capacity reduced by up to 95%
Compromises digestion and absorption of nutrients
- malabsorption is induced due to anatomical changes that bypass absorptive sites in small intestine
Reduces body weight by 35-65%
Resolves co morbidities like diabetes, hyperlipidemia, hypertension
Bariatric surgery resources needed
Pre operative and post operative care
Surgeons and other health professionals
Nutrition is a key player in the entire process
- expertise capacity
- availability of products
“Increase in surgery popularity - more resources needed”
Criteria for bariatric surgery
18 years or older
BMI > or equal to 40 kg/m2 or 35 with serious co morbidities
Absence of
- eating disorder
- major psychiatric diagnosis
- use of tobacco and other controlled substances
Failure of non surgical attempts at weight loss
Types of Bariatric surgery
RESTRICTIVE
- reduced total capacity of the stomach
- promotes satiety with very little food intake
MALABSORPTIVE
- changes in anatomy of the stomach and small intestine
- changes digestion and absorption of nutrients
COMBINED restrictive and malabsorptive
- combination of stomach restriction and change in anatomy of small intestine
- most common (most benefits)
- ROUX-en-Y gastric bypass (RYGP) most common
Key micronutrient issues for Bariatric surgery
- combination of decreased intake and decreased absorption
- often patients come to surgery with micronutrient insufficiencies (poor and large diets)
- poor compliance to nutrient supplements (cost, depression, low tolerance)
- iron (most common), B12, folate, thiamin, D, zinc
Iron
Iron deficiency is the most common micronutrient issue for Bariatric surgery , up to 50%
Reasons:
- reduced intake of heme iron (more bioavailable than non heme) due to poor tolerance to meat (low appetite)
- surgery causes bypass of site for absorption aka malabsorption
- rescued hydrochloride acid in stomach so less ability to reduce ferric iron to ferrous iron to help absorption
- low compliance to iron supplants ( poor digestive tolerance and gastric irritation from supplements)
- could also be caused in part by GI blood loss during surgery
Vitamin B12
Common micronutrient issue with Bariatric surgery
Reasons increased risk of B12 deficiency
- reduced gastric acid produced from the newly created small ouch
- inadequate gastric acid to separate B12 from animal protein
- decreased intrinsic factor
- limited meat intake due to poor tolerance
- low compliance to supplements
Folate
Folate deficiency much less common than B12
Primarily due to poor intake
Absorption is OK
Esaily preventable with a supplement
Supplement always included for prevention
Thiamin
Observations of wernickes encephalopathy thought to be rated to thiamin deficiency symptoms
Research shows most common symptoms of wernickes encephalopathy include
- ataxia: gait abnormalities to not being able to move
- altered mental status: delirium, confusion, alertness and cognition problems
- eye movement disorders
Don’t rly have to know this one
Vitamin D
Risk of vitamin D deficiency due to
- more than half of Bariatric patients have pre existing vitamin and insufficiency
- vitamin D stays can worsen after surgery due to loss of fat and associated vitamin D stores making any pre existing vitamin D insufficiency worse (“vit D stores in adipose and surgery gets rid of adipose”)
- malabsorption due to surgery
- milk is one of the least tolerated foods of Roux-en-Y patients
Zinc
Zinc status is often a problem
- impaired absorption
- reduced protein intake
- poor compliance to supplements
- often under diagnosed
