Nutritional Risks After Surgery - obgynkw

Dr. Abdullah Mijbil Almutawa
Ph.D., MSc., R.D
 Nutritional Risks after Surgery
 Timing your Pregnancy
 Weight Gain During Pregnancy
 Calorie Intake
 Protein Intake
 Micronutrient Deficiencies
 Special Considerations
 References
Nutritional Risks After
 Bariatric surgery increases the risk for nutrient
deficiencies. The severity of risk depends on the type of
procedure a person has had. Here's how they rank from
lowest to highest risk:
 Adjustable gastric banding (Restrictive bariatric
procedure )
 Vertical sleeve gastrectomy (Restrictive bariatric
 Gastric bypass (Malabsorptive operation)
 Bilio-pancreatic diversion (Malabsorptive operation)
Nutritional deficiencies are
caused by decreased:
 Absorption of nutrients from food
 Secretion of stomach acid to aid in digestion and
 Intake of nutrients as a result of food intolerances,
chronic nausea, vomiting and/or diarrhea
Timing Your Pregnancy
 It is recommended that women wait 12-18 months
after surgery before trying to conceive. Why ?
 Rapid weight loss
 Risk of nutritional deficiencies right after surgery.
Weight Gain During
 The amount of weight a woman needs to gain during
pregnancy is based on her body mass index (BMI)
before pregnancy, according to the Institute Of
Medicine, 2009.
Calorie Intake
 Calorie recommendations for the pregnant bariatric
patient include approx. 300 kcal/day above
maintenance guidelines for bariatric surgery.
 Most of the extra calories must come from protein.
 Protein is the most important macronutrient for the
bariatric pt.
 To ensure adequate intake, protein must be
consumed at the beginning of the meal.
 Pregnancy (18 months after bariatric surgery):
 1.1g/kg/day of protein
 Pregnancy (During the 18 months after surgery):
 1.5g/kg/day of protein
 If needed, sugar-free protein shakes may be
Bariatric Food Guide Pyramid
 Calcium deficiency caused by:
 Inadequate consumption
 Malabsorption
 Bypass procedures lead to Calcium deficiency as a result of
excluding the duodenum and proximal jejunum from calcium
 It is recommended to increase the intake from 1000 mg of
calcium citrate with 10 mcg vitamin D to 2000 mg of calcium
citrate with vitamin D (50–150 mcg).
 Calcium Citrate does not require an acidic environment to be
broken down.
 Foods high in Ca: Dairy products – sesame seeds – Broccoli –
Salmon – Sardine – tofu – Soya Beans – Chia seeds - Nuts.
 In general, pregnant women require more Iron.
 Iron in multi vitamin supplements(18mg)is not enough.
 Most of the iron from foods like meats, legumes, and
iron-fortified grains is absorbed in the stomach and the
first part of the small intestine.
 Patient must consult her doctor for Iron
 Calcium, Coffee, tea, and cola sodas can interfere with
iron absorption (decaffeinated or caffeinated).
 Unfortunately, there are no NUTRITIONAL
recommendations for pregnant women after bariatric
treatment YET.
Vitamin B12
 18% of Vitamin B12 deficiency is found in patients
post GS surgery (Gehrer).
 Supplementation must be prescribed by doctor.
 Foods high in Vitamin B12:
Fortified cereals
 Halverson, in his study found 38% of by pass
surgery patients are deficient in Folate.
 Deficiency of Folate is less common in GS surgeries.
 Daily intake of 1mg of Folate has been found to help
prevent deficiency.
 Foods high in Folate: Liver – Sunflower seeds – Leafy
green vegetables – Peas – Beans – Asparagus.
 Zink should be considered especially after
malabsorptive bariatric operations.
 Low levels of zinc have been combined to premature
deliveries, low birth weight, abnormal fetal
development, and spina bifida.
 Optimal dose of zinc required which is 15 mg a day.
 Foods high in Zink: Bran – Low fat roast beef – Veal
liver – pumpkin seeds – dark chocolate – Lamb –
 Studies show low magnesium levels in women who
have had a premature labor.
 During pregnancy requirement for magnesium rises
two times.
 supplementation is obligatory at the dose of 200–
1000 mg daily if states of deficiency occur or when
symptoms of deficiency appear.
 Foods high in Mg: Bran Rice – Oats – Watermelon
seeds – Flaxseeds – Brazil nuts – Almonds.
 Iodine requirement during pregnancy rises twice
during the first trimester.
 WHO recommends its daily intake at the level of
250 mcg.
 Only 150 mcg should be supplemented while the rest
absorbed during nutrition.
 Unfortunately, there are no recommendations for the
pregnant women after bariatric treatment YET.
 Foods high in Iodide: Sea Vegetables like Kelp –
Cranberries – Yogurt – Potatoes – Dairy.
Special Considerations
 To maximize the absorption of Calcium and Iron
supplementation, the two should NOT be taken at the
same time.
 To avoid Constipation:
 Increase fiber intake 25-35g/day
 Moderate Exercise
 Drink Two liters of water between meals
 Sun exposure is a Must for adequate Vit D levels. (Vit D
food fortification is never enough)
 Chewing food slowly has a great effect on micronutrient
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