Julianne M Barredo

Dr. Jasti

FNES 260 Research Methods in Nutrition

13 October, 2021

Nutrition Question and Evidence Assignment

1.) Nutrition Question: If I get bariatric surgery, how will it affect my GI system?

2.) Research Question: Does bariatric surgery increase the risk of nutrient deficiency in over-

weight individuals?

3.) PICO Terms: Population: Over-weight/Obese individuals

Intervention/Independent Variable: Weight-loss/bariatric surgery

Control/Comparison: Weight loss by healthy diet and exercise

Outcome/Dependent Variable: Risk of nutrient deficiency (indicated by poor

absorption in the GI tract)

4.) Cochrane Database for Systematic Reviews: I used search terms “bariatric surgery” AND

“nutrient deficiency”. Several articles came up. I chose one, and the title, and plain language

summary are copied and posted below. This is not a systematic review, but a comparative study.

The search yielded no systematic reviews, however I did leave the information for the

comparative study.

Nutrient deficiencies after laparoscopic roux-en-y gastric bypass and laparoscopic

sleeve gastrectomy: a comparative study.
Introduction: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was the
preferred bariatric procedure in terms of weight loss and remission of co-morbidities,

 however nutrient deficiencies were common. Laparoscopic Sleeve Gastrectomy (LSG)
was increasing in popularity with remarkable effectiveness and less nutrient deficiencies.
Objective: We determine the amount of pre-operative nutrient deficiencies in morbidly
obese patients and compare nutritional status during the first post-operative year between
LRYGB and LSG. Methods: One hundred and seventy-seven patients
underwent Bariatric procedures between January 2011 and December 2013 were assigned
to a standardized follow-up program. Data of interest were pre-operative nutrient status,
percent of excess weight loss (%EWL) at 1 year and nutrient deficiencies during the first
post-operative year. Deficiencies were supplemented when found and excluded from the
analysis. Results: One hundred and fifty morbidly obese patients with completion of
blood withdrawal pre-operatively and during the first post-operative year were included
in the study (64 LRYGB and 78 LSG). Pre-operative nutrient deficiencies were found in
29 patients including 2 iron deficiency and 28 vitamin D deficiency. Post-
operative nutrient deficiencies had no significant difference between both groups (45.1 %
in LRYGB vs 39.1 %, p = 0.629) with significantly higher %EWL at 1 year in LRYGB
(71.9 % in LRYGB vs 53.1 %, p<0.001). Subgroup analysis of iron, folate, vitamin B12
and vitamin D deficiencies showed no significant difference between both groups,
however %EWL at 1 year were also significantly higher in LRYGB (p<0.001).
Conclusion: Nutrient deficiencies in morbidly obese patients are common in Thai
Population that should be concerned and supplemented before
undergoing bariatric procedures. Nutrient deficiencies after Laparoscopic Roux-en-Y
Gastric bypass occur frequently but are comparable with those of Laparoscopic Sleeve
Gastrectomy, however significant weight loss at 1-year follow-up is preferable in
Laparoscopic Roux-en-Y Gastric Bypass.

5.) Abstract for a Narrative Review Article:

Title: Recognizing postoperative nutritional complications of bariatric surgery in the

primary care patient: a narrative review.

 Authors: Chamberlain C, Terry R, Shtayyeh T, Martinez C.

Abstract: Bariatric surgery is an effective treatment for patients with morbid obesity.

However, as safe and common as bariatric procedures have become, multiple

complications can still result. These complications vary depending on the type of

procedure performed (malabsorptive or restrictive) and are often nutritional

derangements from the altered malabsorptive surface of the gastrointestinal tract and

decreased capacity of the stomach. Deficiencies in vitamin D after malabsorptive

procedures such as the Roux-en-Y gastric bypass can result in subsequent hypocalcemia

and bone demineralization, and anemias can also present after surgery from inadequate

vitamin B12 and iron absorption. Because of the prevalence of these deficiencies,

baseline micronutrient testing and postoperative screening are recommended in many

cases. Additionally, supplemental treatment often requires higher doses than those

recommended for healthy adults. The purpose of this narrative review is to outline the

various nutrient deficiencies that can result from bariatric procedures and report

previously-published recommendations for screening and medical treatment of patients

with these deficiencies. This review is directed toward primary care practitioners because

of their unique position in delivering continuity of care and the frequency with which

they will encounter patients who have undergone bariatric surgery and are seeking

counseling regarding weight loss modalities.

Abstract for an Original Research Article:

Title: Micronutrient management following bariatric surgery: the role of the dietitian in
the postoperative period

 Authors: Osland E, Powlesland H, Guthrie T, Lewis C, Memon M.

Abstract: Bariatric surgery is increasingly being utilized to manage obesity and obesity

related comorbidities, but may lead to the development of micronutrient deficiencies

postoperatively. The anatomical, physiological, nutritional and behavioral reasons for

micronutrient vulnerabilities are reviewed, along with recommendations for routine

monitoring and replacement following surgery. The role the dietitian and their

contribution in the postoperative identification, prevention and management of

micronutrient vulnerabilities in bariatric patients is described. Specific considerations

such as the nutritional and dietetic management of pregnant and lactating women post-

bariatric surgery is also discussed.

6.) Answer in my own words: Based on my research of relevant literature, due to the fact that

bariatric surgery, specifically Roux-en-Y, rearranges the structure of the duodenum, ileum, and

the stomach, it is likely nutrient deficiencies may develop. This occurs because of inhibited

absorption of nutrients in the duodenum and small intestine. However, with close monitoring,

regular follow ups, and supplementation as prescribed by a doctor, (physician or

gastroenterologist), nutrient levels are likely to return to normal, or stable.

7.) References:

1.) Chanswangphuvana P, Boonyagard N, Vichajarn P, Techagumpuch A, Pungpapong S-

U, Kitisin K, Tharavej C, Navicharern P, Udomsawaengsup S. Nutrient deficiencies after

laparoscopic roux-en-y gastric bypass and laparoscopic sleeve gastrectomy: a

comparative study. Surgical endoscopy and other interventional techniques. 31 August

2015; 29: S504. https://doi-org.queens.ezproxy.cuny.edu/10.1007/s00464-015-4130-0

 2.) Chamberlain C, Terry R, Shtayyeh T, Martinez C. Recognizing postoperative

nutritional complications of bariatric surgery in the primary care patient: a narrative

review. J Osteopath Med. 1 January 2021; 121(1): 105-112. DOI: 10.7556/jaoa.2020.135

3.) Osland E, Powlesland H, Guthrie T, Lewis C, Memon M. Micronutrient management

following bariatric surgery: the role of the dietitian in the postoperative period. Annals of

Translational Medicine. 2020 March; 8(Suppl 1): S9. doi:10.21037/atm.2019.06.04.

4.) Leeman M, Gadiot RPM, Wijnand JMA, Birnie E, Apers JA, Biter LU, Dunkelgrun

M. Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient

status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI)

Study. British journal of nutrition. 31 May 2020; 123(12): 1434-1440.

5.) Prichard W, Gohel T, Magalona S. Optimizing postoperative bariatric surgery

micronutrients. American journal of gastroenterology. 2020; 115(SUPPL): S595.