Importance of nutritional monitoring following bariatric surgery for a patient with obesity and metabolic complications (#348)
A 36-year-old female with a 12-year history of type 2 diabetes, hypertension, dyslipidaemia, fatty liver, severe obstructive sleep apnea, gastrointestinal reflux disease and grade II obesity was referred to our obesity clinic.
She achieved minimal weight loss with ongoing poor glycaemic control and hence underwent laparoscopic Roux-En-Y bariatric surgery for failed standard lifestyle intervention with multiple associated metabolic complications. There were no immediate perioperative complications and importantly, she did not require any insulin nor oral hypoglycaemic agents on discharge.
She sustained significant ongoing weight loss of 30kg after 3 months with improvement of metabolic parameters including HbA1c reduction from 9.5% to 6.2%. Complications included hair loss and micronutrient deficiency requiring replacement with regular biochemical and body composition monitoring.
The choice of bariatric procedure should be made with careful consideration of the patients’ medical and psychological history. The type of bariatric procedure depends on cost1, surgical expertise2 and goals of metabolic management. There is increasing evidence that durable glycaemic control can be achieved with gastric bypass and appears to provide better restoration of pancreatic beta-cell function and body composition profile.3
Complications of rapid weight loss include micronutrient deficiency, lean muscle mass loss and significant reduction in bone mineral density.4 Despite increasingly good evidence with regard to complications of obesity, data on the potential nutritional complications in the longer term are still lacking.
- Korda RJ, Joshy G, et al. Inequalities in bariatric surgery in Australia: findings from 49 364 obese participants in a prospective cohort study. Med J Aust 2012; 197 (11): 631-636
- Ronellenfitsch U, Schwarzbach M, et al. The Effect of Clinical Pathways for Bariatric Surgery on Perioperative Quality of Care. Obesity Surgery. 2012;22:732-739
- Sangeeta R. Kashyap, Deepak L. et al. Metabolic Effects of Bariatric Surgery in Patients With Moderate Obesity and Type 2 Diabetes: Analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care published ahead of print February 25, 2013
- Saltzman E, Karl JP. Nutrient Deficiencies After Gastric Bypass Surgery. Annual Review of Nutrition. 2013