The main aspects of nutrition when managing patients who have undergone SG and RYGB are presented.
Pre-surgery screening: Vitamin D and calcium have Grade A recommendation for screening as deficiency can be as high as 90%. Vitamin B12 has Grade B recommendation for screening as deficiency can be as high as 2-18% and 6-30% for patients taking PPIs. Folic Acid and Iron have Grade B recommendation for screening as deficiency can be as high as 54% and 45%, respectively. Thiamin, Vitamins A, E, K, zinc and copper have a grade C or D recommendation and should be considered on a case by case basis.
Signs and symptoms: Dry and wet beriberi are early signs of Thiamin deficiency. Wernicke’s encephalopathy and Wernicke-Korsakoff syndrome are advanced and more serious signs of this deficiency. Pernicious anemia, numbness and paresthesia in extremities, ataxia, changes in reflexes, Light-headedness or vertigo, shortness of breath, tinnitus and palpitations are early signs of B12 deficiency. Angina and symptoms of congestive failure and altered mental status are advanced signs of this deficiency. Fatigue, microcytic anemia, glossitis and dysphagia, spoon-shaped nails and palpitations are signs of iron deficiency.
Screening: Screening should be individualized, but as a rule, it should be conducted every 3-6 months in the first year and annually thereafter.
Nutrition: Protein ingestion should be individualized. Carbohydrates, mainly complex ones, should constitute 50% of the daily caloric intake. Fat, mainly unsaturated fats, should constitute 20-35% of the daily caloric intake. RYGB and SG show differences in micronutrient deficiencies after surgery, but supplementation should be provided in both procedures. Multivitamin plus minerals including at least Vitamins B1, B9, B12, A, D, E and K and, Minerals Iron, Calcium, Zinc and Cooper. B12 and D should be supplemented in addition to the multivitamin. Female patients of childbearing age should receive iron and folic acid.
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