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Monitoring of protein intake after bariatric surgery should be mandatory

 

New results from ICAN scientists advocate for a policy of systematic monitoring of protein and micronutrient status before & after adjustable gastric banding (AGB) and gastric bypass (GPB). This moniroring should be coupled with dietetic advice and prescription to prevent the inadequate intakes of protein and other nutrients. Furthermore, systematic vitamins and minerals supplementation should also be considered after AGB, at least in the short term.

The rise of bariatric surgery

Although obesity has become a worldwide epidemic, therapeutic strategies are still scarce. Among them, bariatric surgery, yet reserved for morbid obesity, has demonstrated to be the most efficient procedure. Furthermore, its beneficial metabolic effects have also been proven, which leads experts of the field to consider new and broader indications for patients referred to as metabolic surgery. Potentially this will dramatically increase the actual number of patients undergoing these surgeries (44 000 in France and 468,000 worldwide in 2013).

Nutritional monitoring after bariatric surgery: an urgent need

Nevertheless, such procedures include food restriction and/or reduction of nutrients absorption, potentially leading, in the long term, to an increased risk of nutritional deficiencies in obese patients that are already prone to micronutrient deficiencies. Thus the risk is to swap the obesity disease into a deprivation disease.

While numerous studies have evaluated food intake in the long term after gastric bypass (GBP), only scarce data exist regarding the risk of nutritional deficiencies in the very short term after such procedure. Furthermore, even fewer studies compared GBP and adjustable gastric banding (AGB) in terms of food intake and its biological nutritional consequences.

There is an urgent need to better evaluate food intake along with its biological consequences before, but most importantly after the surgery: the question of nutritional deficiencies’ risk in morbidly obese individuals after bariatric surgery procedures, both in restrictive & malabsorptive procedures like Roux-en-Y bypass (GBP) and purely restrictive ones like adjustable gastric banding (AGB), needs to be addressed.

A new clinical study assessing the short-term post-surgery nutritional status

In this context, Judith Aron and colleagues in Karine Clément‘s team have evaluated (i) food intakes using self-administered web-based 24h dietary record, (ii) global nutrient adequacy in a single score by combining probabilities of adequacy of intake of 24 nutrients, and (iii) bioclinical and micronutrients serum level in 22 French morbidly obese women before AGB or GBP. They have then analyzed the evolution of these parameters in the very short term post-surgery (1 and 3 months).

Their main results, combining dietary and biological evaluation, show that:

1. Before surgery, morbidly obese patients presented suboptimal food intakes, leading to higher risk of micronutrient deficiencies. Subsequently, patients undergoing surgery presented nutritional deficiencies for protein, iron and thiamine.

2. After 1 and 3 months, both procedures resulted in an average 17% decrease of the global nutrient adequacy score. While international recommendation strategy of systematic vitamins supplementation after GBP prevented the decrease of the global nutrient adequacy score, the lack of such strategy after AGB induced nutritional deficiencies.

3. Both procedures induced a severe decrease in protein intake resulting in mild protein depletion in half of the cohort. This result suggests that a special attention to protein intake is needed in order to recommend an increase or add a specific supplementation in both surgical models.

The big picture: improving the care of bariatric surgery patients

This study has just been published in PLOS One. It comes on the heels of a previous study from ICAN scientists, which showed that Roux-en-Y Gastric Bypass and Sleeve Gastrectomy have comparable consequences on food intakes and nutritional adequacy of the diet in the first year post surgery. Taken together, these results have important clinical and practical implications to the field of clinical nutrition and more specifically to the care of bariatric surgery patients.

 

Original Research

Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding
Judith Aron-Wisnewsky, Eric O Verger, Carine Bounaix, Maria Carlota Dao, Jean-Michel Oppert, Jean-Luc Bouillot, Jean-Marc Chevallier, Karine Clément
PLOS One, February 18, 2016
doi: 10.1371/journal.pone.0149588

See also:

Bariatric surgery and the risk of micronutrient deficiencies

Micronutrient and Protein Deficiencies After Gastric Bypass and Sleeve Gastrectomy: a 1-year Follow-up
Verger EO, Aron-Wisnewsky J, Dao MC, Kayser BD, Oppert JM, Bouillot JL, Torcivia A, Clément K.
Obes Surg. 2015 Jul 24.
doi: 10.1007/s11695-015-1803-7

Contacts

Dr. Judith Aron-Wisnewsky, MD, PhD
Service de Nutrition – pôle cardiométabolisme
Institute of Cardiometabolism And Nutrition ICAN (AP-HP/Inserm/UPMC)
AP-HP – Hopital La Pitié-Salpétrière
+33 142 177 541
judith.aron-wisnewsky@aphp.fr

Prof. Karine Clément, MD, PhD
Institute of Cardiometabolism And Nutrition ICAN (AP-HP/Inserm/UPMC)
AP-HP – Hôpital La Pitié-Salpêtrière
+33 142 177 928
k.clement@ican-institute.org